Share this article on:

Impaired Gastric Emptying and Small Bowel Transit in Children With Mitochondrial Disorders

Bhardwaj, Jatinder*; Wan, David Q.; Koenig, Mary Kay; Liu, Yuying*; Hashmi, Syed Shahrukh*; Rhoads, Jon Marc*

Journal of Pediatric Gastroenterology & Nutrition: August 2012 - Volume 55 - Issue 2 - p 194–199
doi: 10.1097/MPG.0b013e3182514805
Original Articles: Gastroenterology

Objectives: The primary aim of our study was to evaluate gastric emptying (GE) and intestinal transit time (ITT) in children with mitochondrial disorders (MD), and secondarily to evaluate the effect of prokinetics in those with prolonged GE.

Methods: We enrolled subjects 3 to 18 years with MD and having any of the following gastrointestinal (GI) symptoms: abdominal pain, vomiting, constipation, diarrhea, or gastroesophageal reflux. Abdominal pain was scored by visual analog pain scale (1–10). Age-appropriate diet was labeled with radioactive technetium-99 sulfur colloid and its movement tracked along the GI tract. Delayed GE based on our institutional standards was defined as half emptying time >90 minutes for a solid and >60 minutes for a semisolid meal. Prolonged ITT was defined as >4 hours for the tracer to pass from mouth to cecum. A prokinetic was instituted to those with delayed GE, and the study was repeated if possible in 4 to 8 weeks.

Results: Of the 26 subjects, 18 (69%) had delayed GE (median GE 99 minutes) and 12 (46%) had prolonged ITT. The study was repeated in 9 subjects after administering a prokinetic for >1 month. GE normalized in only 3 subjects (median GE on treatment 128 minutes). Mean abdominal pain score, which was 4.8 (max 10) in the 9 subjects, did not improve (5.6 after prokinetic therapy).

Conclusions: A high prevalence of delayed GE and prolonged ITT was seen in children with MD having GI symptoms, and these abnormalities were poorly responsive to prokinetic therapy.

*Department of Pediatrics

Department of Neurology

Department of Nuclear Medicine, University of Texas Health Science Center at Houston Medical School, Houston, TX.

Address correspondence and reprint requests to Jatinder Bhardwaj, MD, University of Texas Health Science Center-Houston, 6431 Fannin St, MSB 3.137, Houston, TX 77030 (e-mail:

Received 26 July, 2011

Accepted 21 February, 2012

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website (

The present study was financially supported by a grant from the Hermann Foundation.

The authors report no conflicts of interest.

© 2012 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,