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The significance of gastric emptying in children with intestinal malrotation
Insights
Children with intestinal malrotation often have ongoing digestive issues. Slow gastric emptying, linked to poor stomach movement, causes vomiting, while rapid movement causes bloating and diarrhea, not GER.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Nuclear Medicine
Background:
- Persistent gastrointestinal symptoms are a frequent complication following surgical repair of intestinal malrotation in children.
- Previous studies have not fully elucidated the specific mechanisms underlying these persistent postoperative symptoms.
Purpose of the Study:
- To investigate the relationship between gastric emptying, gastric peristalsis, and gastroesophageal reflux (GER) in children with a history of intestinal malrotation.
- To identify the primary drivers of persistent gastrointestinal symptoms in this pediatric population.
Main Methods:
- Gastric emptying was assessed using 99m-Tc sulfur colloid scintigraphy at 30 and 60 minutes post-ingestion.
- Gastric peristalsis was evaluated using a corrected gastric emptying measurement accounting for gastroesophageal reflux.
- Esophageal pH monitoring was performed for 18–24 hours to quantify GER.
Main Results:
- Patients experiencing vomiting showed significantly slower gastric emptying and peristalsis compared to asymptomatic patients.
- Children with persistent bloating and diarrhea exhibited rapid gastric peristalsis.
- Gastroesophageal reflux was prevalent (79%) in the study cohort, particularly in children under two years of age, irrespective of symptoms.
Conclusions:
- Clinical symptoms in children with intestinal malrotation appear more strongly associated with abnormal gastric peristalsis patterns (either excessively slow or rapid) than with the presence of GER.
- GER is common in young children with intestinal malrotation but may not be the sole or primary cause of persistent symptoms.
Abstract:
Persistent gastrointestinal symptoms are common postoperatively in children with intestinal malrotation. We investigated this problem in 14 children with intestinal malrotation who had a Ladd procedure (3 patients), gastroschisis repaired (6 patients), or omphalocele repaired (5 patients) between one month and 15 years prior to study. In 13 patients, gastric emptying was measured at 30 minutes (%GE30) and at 60 minutes (%GE60) following ingestion of 99m-Tc sulfur colloid in apple juice. We estimated the degree of gastric peristalsis using the %GE corrected for immediate postcibal gastroesophageal reflux (corrected %GE). Patients with vomiting exhibited slow gastric emptying compared to patients without vomiting (%GE30: 14.0 +/- 5.5 v 32.5 +/- 4.2, P less than .005). The slow gastric emptying was related to slow gastric peristalsis (corrected %GE30: 20.3 +/- 5.0 v 47.1 +/- 6.0, P less than .005). In all 5 patients with persistent bloating and diarrhea, gastric peristalsis was rapid at 30 minutes (corrected %GE30 = 56.7 +/- 4.2) and at 60 minutes (corrected %GE60 = 69.5 +/- 5.3). To assess the role of gastroesophageal reflux (GER) in persisting symptoms, all children had extended (18 to 24 hours) esophageal pH monitoring. Eleven (79%) of the 14 patients demonstrated GER by esophageal pH monitoring, including four of six patients without reflux symptoms. All ten children under two years of age demonstrated GER regardless of symptoms or congenital anatomic abnormality. In conclusion, GER is common in patients under two years of age with intestinal malrotation, but clinical symptoms seem related more to extreme variations in gastric peristalsis than to GER.