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Clinical Characterization of Pediatric Gastroparesis Using a Four-hour Gastric Emptying Scintigraphy Standard
Sharon Wolfson1, Zoe Wilhelm2, Antone R Opekun2,3
1Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA.
Insights
Gastroparesis (GP) in children presents diverse characteristics and outcomes, with significant age and sex-based variations. The 4-hour gastric emptying scintigraphy (GES) standard reveals these differences in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Scintigraphy and Imaging
- Clinical Outcomes Research
Background:
- Four-hour gastric emptying scintigraphy (GES) is the gold standard for diagnosing gastroparesis (GP) in adults and children.
- Previous pediatric studies have not consistently utilized this standardized 4-hour GES protocol.
- Understanding GP characteristics in children using standardized methods is crucial for effective management.
Purpose of the Study:
- To characterize pediatric gastroparesis (GP) using the standardized 4-hour gastric emptying scintigraphy (GES).
- To compare the clinical features and outcomes of gastroparesis (GP) between children and adolescents.
- To identify age- and sex-specific differences in pediatric gastroparesis (GP).
Main Methods:
- Retrospective chart review of pediatric patients diagnosed with GP via 4-hour GES.
- Systematic collection of demographics, BMI, symptoms, comorbidities, etiologies, therapies, and healthcare utilization.
- Comparison of symptoms and outcomes (no improvement, improvement, complete resolution) over a median follow-up of 22 months.
Main Results:
- A total of 239 pediatric patients were analyzed (mean age 12.1 years, 70% girls).
- Idiopathic GP was the most common etiology; 30.3% achieved complete symptom resolution, 34.8% had some improvement, and 34.8% showed no improvement.
- Adolescents showed higher female predominance and nausea; girls reported more abdominal pain, nausea, and dysautonomia; boys had more regurgitation, GERD, and rumination.
Conclusions:
- The 4-hour GES standard reveals broad clinical characteristics and varied outcomes for childhood gastroparesis (GP).
- Significant age-related differences exist, with adolescents exhibiting distinct symptom profiles compared to younger children.
- Sex-based differences in symptoms and comorbidities are evident in pediatric gastroparesis (GP).
Objectives:
Four-hour gastric emptying scintigraphy (GES) is the recommended method to identify both adult and childhood gastroparesis (GP). Previous pediatric studies have, however, not used this standard. We sought to determine the characteristics and outcomes of children versus adolescents with GP using the 4-hour GES evaluation.
Methods:
We performed a retrospective chart review of pediatric patients diagnosed with GP by 4-hour GES (>10% retention at 4 hours). Demographics, body mass index, GP-related symptoms, comorbidities, etiologies, therapies (eg, medications), healthcare utilization, and response to therapy were captured systematically. Symptoms were compared from the initial versus last gastroenterology visit. Outcomes were categorized as no improvement; improvement (resolution of at least 1 symptom while remaining on therapy); and complete resolution of symptoms.
Results:
A total of 239 subjects (12.1 ± 4.1 years [mean ± standard deviation], 70% girls) were included. The identified characteristics of childhood GP were broad with idiopathic GP being the most common etiology. Outcomes over a median of 22 months (25%-75%: 9.0-45.5 months) were 34.8% no improvement, 34.8% some improvement, and 30.3% with complete symptom resolution. Compared to younger children, adolescents had a higher female predominance (P < 0.01) and were more likely to have nausea (P = 0.006). Girls were more likely to have abdominal pain (P = 0.001), nausea (P = 0.03), and a documented diagnosis of dysautonomia (P = 0.03). Boys were more likely to have regurgitation (P = 0.006), gastroesophageal reflux disease (P = 0.02), and rumination (P = 0.02).
Conclusions:
Using the 4-hour GES standard, childhood GP has broad clinical characteristics and outcomes. There are several significant age- and sex-based differences in childhood GP.
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