Causal relationship between delayed gastric emptying and gastroesophageal reflux in patients with neurological impairment.
OBJECTIVE
To investigate the causal relationship between delayed gastric emptying (DGE) and gastroesophageal reflux (GER) in patients with neurological impairment (NI).


METHODS
Subjects included 30 NI patients (age, 1-34 years; median, 6 years). Combined multichannel intraluminal impedance-pH (MII-pH) monitoring and (13)C-breath test evaluated acid/non-acid reflux episodes (RE) and gastric emptying rates, respectively. Values are shown with medians and ranges.


RESULTS
Percentage time for esophageal pH < 4.0 (reflux index: RI) and numbers for total RE and RE > 5 min were 8.3 (0-35.7), 44 (0-129), and 5 (0-22), respectively. Total percentage time and bolus RE numbers were 1.4 (0.0-6.9) and 49 (2-159), respectively. Median bolus clearance time was 16 s (9-45). T 1/2, T lag, and GEC were 103 s (75-204), 54 s (18-97), and 3.4 (2.3-4.3), respectively. Gastric emptying rates and acid/non-acid reflux parameters were not significantly correlated, except T 1/2 correlated significantly with the numbers of RE > 5 min (p = 0.04). T 1/2 inversely correlated with bolus clearance time (p = 0.01). Reflux parameters between DGE and non-DGE patients were not significantly different, except median bolus clearance time was significantly shorter in DGE patients (p = 0.01).


CONCLUSIONS
NI patients showed a wide range of gastric emptying rates without any significant causal relationship between DGE and GER.
Department of Pediatric Surgery, Hamamatsu University School of Medicine, 1-20-1 Handayama Higashi-ku Hamamatsu, Shizuoka, 431-3192, Japan. kawahara@hama-med.ac.jp.
Hisayoshi
H
Kawahara
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho Izumi, Osaka, 594-1101, Japan.
Yuko
Y
Tazuke
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho Izumi, Osaka, 594-1101, Japan.
Hideki
H
Soh
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho Izumi, Osaka, 594-1101, Japan.
Noriaki
N
Usui
Department of Pediatric Surgery, Osaka Medical Center and Research Institute for Maternal and Child Health, 840 Murodocho Izumi, Osaka, 594-1101, Japan.
Masahiro
M
Fukuzawa
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D050782:Esophageal pH Monitoring; D005260:Female; D005764:Gastroesophageal Reflux / Q000150:complications*; D018589:Gastroparesis / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000150:complications*; D055815:Young Adult
13C-breath test; Combined multichannel intraluminal impedance–pH (MII–pH) monitoring; Delayed gastric emptying (DGE); Gastroesophageal reflux (GER)