Clinical characterization of pediatric gastroparesis using a four-hour gastric emptying scintigraphy standard

Authors: WOLFSON, SHARON - Children'S Hospital - Philadelphia, Pennsylvania; WILHELM, ZOE - Baylor College Of Medicine; OPEKUN, ANTONE - Baylor College Of Medicine; ORTH, ROBERT - Non ARS Employee; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); CHUMPITAZI, BRUNO - Baylor College Of Medicine

Submitted to: Journal of Pediatric Gastroenterology and Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/1/2021
Publication Date: 6/1/2021
Citation: Wolfson, S., Wilhelm, Z., Opekun, A.R., Orth, R., Shulman, R.J., Chumpitazi, B.P. 2021. Clinical characterization of pediatric gastroparesis using a four-hour gastric emptying scintigraphy standard. Journal of Pediatric Gastroenterology and Nutrition. 72(6): 848-853. https://doi.org/10.1097/MPG.0000000000003089.
DOI: https://doi.org/10.1097/MPG.0000000000003089

Interpretive Summary: Scintigraphy is the test used to find out if stomach emptying is normal, too slow, or too fast. Previous studies describing the symptoms that children with very slow stomach emptying (gastroparesis) experience did not necessarily use the recommended type of scintigraphy. In this study only those children who had a correctly performed scintigraphy were studied. The study showed that girls were more likely than boys to have belly pain and nausea. In adolescents girls were affected more than boys. Further investiagtions to evaluate other testing for stomach emptying is needed.

Technical Abstract: Four-hour gastric emptying scintigraphy (GES) is the recommended method to identify both adult and childhood gastroparesis (GP). Previous pediatric studies have, however, not used this standard. We sought to determine the characteristics and outcomes of children versus adolescents with GP using the 4-hour GES evaluation. We performed a retrospective chart review of pediatric patients diagnosed with GP by 4-hour GES (>10% retention at 4 hours). Demographics, body mass index, GP-related symptoms, comorbidities, etiologies, therapies (eg, medications), healthcare utilization, and response to therapy were captured systematically. Symptoms were compared from the initial versus last gastroenterology visit. Outcomes were categorized as no improvement; improvement (resolution of at least 1 symptom while remaining on therapy); and complete resolution of symptoms. A total of 239 subjects (12.1 +/- 4.1 years [mean +/- standard deviation], 70% girls) were included. The identified characteristics of childhood GP were broad with idiopathic GP being the most common etiology. Outcomes over a median of 22 months (25%-75%: 9.0-45.5 months) were 34.8% no improvement, 34.8% some improvement, and 30.3% with complete symptom resolution. Compared to younger children, adolescents had a higher female predominance (P < 0.01) and were more likely to have nausea (P = 0.006). Girls were more likely to have abdominal pain (P = 0.001), nausea (P = 0.03), and a documented diagnosis of dysautonomia (P = 0.03). Boys were more likely to have regurgitation (P = 0.006), gastroesophageal reflux disease (P = 0.02), and rumination (P = 0.02). Using the 4-hour GES standard, childhood GP has broad clinical characteristics and outcomes. There are several significant age- and sex-based differences in childhood GP.