title: Delayed gastric emptying and typical scintigraphic gastric curves in children with gastroesophageal reflux disease: could pyloromyotomy improve this condition?
abstract: OBJECTIVE
  Delayed gastric emptying (DGE) is a cofactor in the etiopathogenesis of gastroesophageal reflux disease (GERD). Scintigraphy is the criterion standard to evaluate gastric emptying (GE). This study aims to define typical scintigraphic activity-time curves (ATCs) related to DGE and esophageal atresia (EA) and to demonstrate the effectiveness of pyloromyotomy (P) in improving GE.
  
  
  METHODS
  Since 2002, 83 children underwent Nissen fundoplication. Patients were divided into 2 groups: group I, GERD-only patients; group II, patients with GERD owing to EA. Depending on preoperative scintigraphy, each group was subdivided into 2 subgroups. Before surgery and 1 year after, endoscopy and scintigraphy were performed. In the presence of DGE, P was associated with Nissen fundoplication. Gastric emptying differences at baseline and at follow-up were estimated by the Student t test. Pre- and post-ATCs were evaluated by the χ(2) test.
  
  
  RESULTS
  During follow-up, GE completely normalized in subgroups with DGE. Scintigraphic ATC analysis documented an association between DGE and a typical rectilinear fitting, with a higher rate in EA patients. After P, the scintigraphic pattern changed in an exponential manner related to a faster GE.
  
  
  CONCLUSIONS
  Delayed gastric emptying is frequent in EA, and the scintigraphic ATCs are typical. Pyloromyotomy is a safe and effective technique to fully normalize GE.
authors: Digestive Surgery and Endoscopy Unit, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. tamara.caldaro@opbg.net
authors: Tamara
authors: T
authors: Caldaro
authors: Maria Carmen
authors: MC
authors: Garganese
authors: Filippo
authors: F
authors: Torroni
authors: Gianclaudio
authors: G
authors: Ciofetta
authors: Paola
authors: P
authors: De Angelis
authors: Giovanni Federici
authors: GF
authors: di Abriola
authors: Francesca
authors: F
authors: Foschia
authors: Francesca
authors: F
authors: Rea
authors: Erminia
authors: E
authors: Romeo
authors: Luigi
authors: L
authors: Dall'Oglio