Spectrum of Gastroparesis in Children

Waseem, Shamaila*; Islam, Saleem; Kahn, Genie; Moshiree, Baharak; Talley, Nicholas J.

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e31824cf06e
Original Articles: Gastroenterology
Abstract

Background: Gastroparesis (GP) is characterized by delayed gastric emptying in the absence of mechanical outlet obstruction. Symptoms may include nausea, vomiting, bloating, early satiety, abdominal pain, and weight loss. Delayed gastric emptying of a solid-phase meal assessed by radionuclear scintigraphy is the criterion standard for diagnosis. The prevalence of GP is difficult to estimate due to the lack of a validated, widely available diagnostic test that can be applied in primary care. The extent of this problem in children is unknown.

Methods: We studied a cohort of children with GP diagnosed by radionuclear scintigraphy to identify demographics, symptoms, comorbidities, treatment, and outcomes. A retrospective analysis of 239 patients between ages 0 and 21 years was performed.

Results: The mean age of presentation was 7.9 years, and boys and girls were almost equally affected, that is, 48.5% and 51.5%, respectively. Vomiting was the most frequent presenting symptom (68%), followed by abdominal pain (51%), nausea (28%), weight loss (27%), early satiety (25%), and bloating (7%). Almost 75% of patients responded to intravenous erythromycin administered provocatively during gastric scintigraphy. In a majority of the patients, no cause was identified, that is, idiopathic GP (70%), followed by drugs (18%) and postsurgical (12.5%) causes. Only 4% patients had diabetic GP, and our population was essentially narcotic naïve (2%). After an average of 24 months’ follow-up, the most common complication was esophageal reflux (67%). Despite different therapeutic modalities, by the end of the follow-up period, a significant improvement in symptoms was reported by an average of 60%, regardless of sex, age, or degree of emptying delay.

Conclusions: GP has a good prognosis in childhood despite different etiologies, symptom presentation, and therapy.

Author Information

*Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN

Department of Pediatrics, Shands Hospital at the University of Florida, Gainesville, FL

Department of Medicine, University of Newcastle, Callaghan, Australia.

Address correspondence and reprint requests to Shamaila Waseem, MD, Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Indiana University School of Medicine/Riley Hospital for Children, 705 Riley Hospital Dr, ROC 4210, Indianapolis, IN 46202 (e-mail: shwaseem@iupui.edu).

Received 17 December, 2010

Accepted 16 January, 2012

Advance Postgraduate Program in Clinical Investigation (APPCI), an NIH-funded K30 award program of which Shamaila Waseem was a fellow, provided funding for study design and statistical analysis.

The authors report no conflicts of interest.

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