Gastric contents in pediatric patients following bone marrow transplantation.
BACKGROUND
Graft versus host disease (GVHD) of the gut is thought to delay gastric emptying and so may increase the risk of aspirating retained contents while under anesthesia. Knowing that gastric emptying is delayed in patients with GVHD might lead one to choose to intubate the trachea for all patients with suspected GVHD, who present for diagnostic esophagogastricduodenoscopy (EGD). We are not aware of published data that gives specific guidance as to the need for intubation in the pediatric bone marrow or stem cell transplantation (BMT) population. This review was intended to evaluate the gastric contents (pH and volume) in this group of patients, to provide anesthesiologists with data that would inform their decisions about airway management for these patients.


METHODS
Retrospective chart review of patients <or=19 years of age undergoing EGD between 2004 and 2006. Gastric content volume and pH were measured in addition to underlying disease state and treatment. We compared BMT patients with suspected GVHD to nontransplant patients with other underlying gastrointestinal conditions.


RESULTS
Data were obtained for 77 patients post-BMT undergoing EGD, including 40 patients whose biopsies and endoscopic findings were positive for GVHD, and 37 patients with no demonstrable GVHD. Records of 144 non-BMT patients undergoing EGD within the same study period were also reviewed.


CONCLUSIONS
Patients in the BMT group overall did not have higher volumes when compared to non-BMT patients. A secondary comparison of BMT patients who were found to have GVHD vs BMT patients without GVHD suggests that gastric content volume may be elevated with GVHD. Patients in the BMT group had statistically significantly higher gastric pH than patients in the non-BMT group. It is possible that the higher gastric volume in the GVHD-positive group could put them at slightly higher risk for aspiration, but the severity of any pneumonitis, should aspiration occur, might be mitigated, by the tendency toward a higher gastric pH in the BMT patients.
Wahbeh
Ghassan
G
Department of Pediatrics, Division of Gastroenterology, Hepatology, and Nutrition, Seattle Children's, University of Washington School of Medicine, Seattle, WA 98105, USA.
Rubens
Daniel
D
Katz
Jason R
JR
Seidel
Kristy
K
Rampersad
Sally E
SE
Murray
Karen F
KF
D016026:Bone Marrow Transplantation; D002648:Child; D005260:Female; D005746:Gastric Emptying; D005766:Gastrointestinal Contents; D006086:Graft vs Host Disease; D006801:Humans; D006863:Hydrogen-Ion Concentration; D007442:Intubation, Intratracheal; D008297:Male; D012189:Retrospective Studies