title: Systematic review of the impact of feed protein type and degree of hydrolysis on gastric emptying in children.
abstract: BACKGROUND
  The choice of infant formula is thought to play an important role on gastric emptying (GE) in a variety of gastrointestinal disorders. It is known that many ingredients impact on GE, including the type of protein and level of hydrolysis. In clinical practice, feeds are often recommended due to putative improved GE related to the type of protein and level of hydrolysis, however whether this is scientifically justified still needs to be established. A systematic review comparing the impact of protein type and hydrolysis on GE in children was therefore performed.
  
  
  METHODS
  The Patient, Intervention, Comparison and Outcome system was used. A structured literature search was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, searching PubMed, Cochrane databases and Google Scholar from 1990 to 2014. We only included articles published in full text English language using specific search terms, including both scintigraphy and C13-octanoic acid breath test.
  
  
  RESULTS
  We identified 126 publications of which 20 were eligible for inclusion but only 8 were included. Studies reviewed GE in both healthy children as well as those with neurodevelopmental delay and reflux. Two studies investigating GE of breast milk versus formula indicated a faster GE for breast milk. Four studies found that feeds containing whole whey in varying amounts emptied faster than predominant whole casein feeds and one study found no difference in GE. Five studies investigated a mix of whole versus hydrolysed protein and found conflicting results related to study population and hydrolysis.
  
  
  CONCLUSIONS
  Breast milk has a faster GE than formula milk. Although there seems to be a trend towards whey feeds emptying faster, different methodologies, feed compositions and patient groups makes it difficult to draw firm conclusions. Future studies should be performed with comparable feeds in populations where increased GE may be of clinical benefit.
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK. Rosan.Meyer@gosh.nhs.uk.
authors.forename: Rosan
authors.initials: R
authors.lastname: Meyer
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK. ruxinfoong@gmail.com.
authors.forename: Ru-Xin Melanie
authors.initials: RX
authors.lastname: Foong
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK. n.thapar@ucl.ac.uk.|Institute of Child Health, University College, London, UK. n.thapar@ucl.ac.uk.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Thapar
authors.affiliation: KU Leuven, TARGID, Leuven, Belgium. Stamatiki.Kritas@kuleuven.be.
authors.forename: Stamatiki
authors.initials: S
authors.lastname: Kritas
authors.affiliation: Gastroenterology Department, Great Ormond Street Hospital for Children NHS foundation Trust, London, UK. Neil.Shah@gosh.nhs.uk.|Institute of Child Health, University College, London, UK. Neil.Shah@gosh.nhs.uk.
authors.forename: Neil
authors.initials: N
authors.lastname: Shah
mesh_terms: D004044:Dietary Proteins / Q000737:chemistry / Q000378:metabolism*; D005746:Gastric Emptying / Q000502:physiology*; D005764:Gastroesophageal Reflux / Q000378:metabolism; D006801:Humans; D006868:Hydrolysis; D007223:Infant; D041943:Infant Formula / Q000737:chemistry*; D007231:Infant, Newborn; D008895:Milk, Human / Q000378:metabolism*; D000067816:Whey Proteins / Q000378:metabolism
chemical_list: D004044:Dietary Proteins; D000067816:Whey Proteins