title: Delayed gastric emptying in gastroesophageal reflux disease: the role of malrotation.
abstract: The association between gastroesophageal reflux (GER) and intestinal malrotation (IM) has been well described. Delayed or impaired gastric emptying in IM is thought to be a contributing factor in the development of gastroesophageal reflux disease (GERD). The current study assessed the role of malrotation in delayed gastric emptying in children with GERD. We also evaluated the interactions between GERD, malrotation, gastric pH abnormalities, and gastric dysmotility. Sixty-seven patients between 1 and 5 years of age (mean 3.08+/-1.2) and with symptoms of GER, such as emesis, reactive or recurrent lung disease, and/or growth retardation, were studied in 2001-2005. Upper and lower gastrointestinal contrast studies were performed for the diagnosis of malrotation. Gastric motility was evaluated with a liquid gastric emptying protocol. GER was documented by upper gastrointestinal studies, scintigraphy, and/or 24-h pH monitoring. In our series of 44 children with GERD, there was an unexpectedly high incidence of IM: 54.5% (24/44). IM has previously been known to occur in 25% of patients with GERD. GERD was found in 24 (82.7%) of 29 patients with IM. Mean nuclear gastric emptying (MNGE) was 51.6+/-8.04 min in patients with isolated GERD and 96.6+/-20.5 min in children with IM and GERD. There was a statistically significant difference in MNGE time (p<0.05) between children with primary GERD and in those with GERD and IM. Esophageal pH monitoring showed that mean fraction time below pH 4 was 7.06+/-1.1% in patients with isolated GERD and 14.7+/-4.1% in patients with IM and GERD. GERD is common in children between 1 and 5 years old. Using gastric emptying studies and esophageal pH monitoring, we have shown that gastric dysmotility and esophageal pH abnormalities are highly prevalent, especially in children with malrotation compared with children with isolated GERD. These findings suggest that malrotation is an important factor responsible for delayed gastric emptying in GERD. Hence, we recommend that all infants and children with GERD and delayed gastric emptying undergo careful evaluation for malrotation.
authors.affiliation: Department of Pediatric Surgery, Medical School of Inonu University, Inönü Universitesi, Turgut Ozal Tip Merkezi, Cocuk Cerrahisi Anabilim Dali, 44069 Malatya, Turkey. sdemirbilek@inonu.edu.tr
authors.forename: Savaş
authors.initials: S
authors.lastname: Demirbilek
authors.forename: Abdurrahman
authors.initials: A
authors.lastname: Karaman
authors.forename: Kubilay
authors.initials: K
authors.lastname: Gürünlüoğlu
authors.forename: Melih
authors.initials: M
authors.lastname: Akin
authors.forename: Erkan
authors.initials: E
authors.lastname: Taş
authors.forename: Rauf Tuğrul
authors.initials: RT
authors.lastname: Aksoy
authors.forename: Ersoy
authors.initials: E
authors.lastname: Kekilli
mesh_terms: D002675:Child, Preschool; D005260:Female; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D007223:Infant; D007422:Intestines / Q000002:abnormalities*; D008297:Male; D011877:Radionuclide Imaging; D012189:Retrospective Studies