Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

Abstract

Background Due to scarcity of scientific literature on pediatric gastroparesis, there is a need to summarize current evidence and identify areas requiring further research. The aim of this study was to provide an evidence‐based review of the available literature on the prevalence, pathogenesis, clinical presentation, diagnosis, treatment, and outcomes of pediatric gastroparesis. Methods A search of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines with the following databases: PubMed, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Web of Science. Two independent reviewers screened abstracts for eligibility. Key Results Our search yielded 1085 original publications, 135 of which met inclusion criteria. Most articles were of retrospective study design. Only 12 randomized controlled trials were identified, all of which were in infants. The prevalence of pediatric gastroparesis is unknown. Gastroparesis may be suspected based on clinical symptoms although these are often non‐specific. The 4‐hour nuclear scintigraphy scan remains gold standard for diagnosis despite lack of pediatric normative comparison data. Therapeutic approaches include dietary modifications, prokinetic drugs, and postpyloric enteral tube feeds. For refractory cases, intrapyloric botulinum toxin and surgical interventions such as gastric electrical stimulation may be warranted. Most interventions still lack rigorous supportive data. Conclusions Diagnosis and treatment of pediatric gastroparesis are challenging due to paucity of published evidence. Larger and more rigorous clinical trials are necessary to improve outcomes.

Gastroparesis in the Pediatric Patient: Children Are Not Little Adults

“…Diabetes mellitus is the most common identifiable etiology of gastroparesis in adults, but accounts for only 2-4% of gastroparesis in children [6,7]. The underlying pathophysiology of gastroparesis in children is not well understood, although there is limited data suggesting an association between antral eosinophils, mast cell degranulation, and delayed gastric emptying [2].…”

“…Nausea, early satiety and weight loss are reported in about a quarter of children with this diagnosis [6,7]. The presentation of gastroparesis in children is similar to the presentation of functional dyspepsia, and up to half of children with functional dyspepsia have delayed gastric emptying [2]. Presentation can change with age, with infants and children more likely to experience vomiting (69% and 45%, respectively) than adolescents (28%).…”

“…Unfortunately, domperidone is currently only available in the United States through the Food and Drug Administration Investigational New Drug application process [3]. Cisapride, a 5-hydroxytryptamine type 4 (HT4) receptor agonist, was previously used for gastroparesis but has been removed from commercial use in the United States because of the risk of ventricular arrhythmias [2].…”

“…As it is in adults, gastroparesis in children is defined as a delay in gastric emptying in the absence of mechanical obstruction that is accompanied by corresponding symptoms like nausea, vomiting, early satiety, bloating and abdominal pain [1,2]. This disorder results from neuromuscular dysfunction that can be idiopathic in nature or associated with underlying diseases, medical or surgical interventions or preceding infections.…”

“…Although the definition and presentation of gastroparesis in adults and children share similarities, even the limited available literature on gastroparesis in children demonstrates key differences between gastroparesis in these two populations. The diagnosis and management of gastroparesis in children has thus far leaned heavily on research performed in adult patients, but it is becoming increasingly clear that gastroparesis in children is a distinct entity and that there are limitations to the applicability of adult research to the care of children [2,3]. In this review, we examined the similarities and differences between gastroparesis in children and adults in clinical presentation, diagnosis, treatment and outcomes.…”