Spectrum of gastroparesis in children.
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.
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Riley Hospital for Children, Indiana University School of Medicine, Indianapolis, IN 46202, USA. shwaseem@iupui.edu
Shamaila
S
Waseem
Saleem
S
Islam
Genie
G
Kahn
Baharak
B
Moshiree
Nicholas J
NJ
Talley
D015746:Abdominal Pain / Q000453:epidemiology / Q000209:etiology; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D048909:Diabetes Complications; D064420:Drug-Related Side Effects and Adverse Reactions / Q000150:complications; D004917:Erythromycin / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005746:Gastric Emptying; D005764:Gastroesophageal Reflux / Q000453:epidemiology / Q000209:etiology; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D018589:Gastroparesis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology; D006801:Humans; D007223:Infant; D008297:Male; D009325:Nausea / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications; D015995:Prevalence; D011379:Prognosis; D014839:Vomiting / Q000453:epidemiology / Q000209:etiology; D015431:Weight Loss; D055815:Young Adult
D005765:Gastrointestinal Agents; D004917:Erythromycin