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13 C-Spirulina Gastric Emptying Breath Test Normative Values in Healthy Children: A Multicenter Study With Comparison
Katja Karrento1, Bruno P Chumpitazi2, Liyun Zhang3
1Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Insights
This study establishes normal gastric emptying values for children using the 13C-Spirulina gastric emptying breath test (13C-GEBT). It found significant sex and pubertal differences, providing crucial data for diagnosing pediatric gastroparesis.
Area of Science:
- Pediatric Gastroenterology
- Diagnostic Imaging
- Physiology
Background:
- Diagnosing pediatric gastroparesis is challenging due to a lack of normative data in children.
- The 13C-Spirulina gastric emptying breath test (13C-GEBT) offers a non-radioactive method for assessing gastric emptying.
Purpose of the Study:
- To determine normative gastric emptying values in healthy children using 13C-GEBT.
- To compare gastric emptying between healthy children and those with gastroparesis-like symptoms (GLS).
- To identify sex and pubertal differences in pediatric gastric emptying.
Main Methods:
- 301 healthy children (ages 7-18) underwent the 13C-GEBT, involving 10 breath samples over 4 hours.
- Gastric emptying was assessed by measuring 13CO2 excretion rate (kPCD), peak kPCD, time to peak (Tmax), area under the curve (AUC), and breath test half emptying time (BT t ½).
- Results were compared to data from children with GLS.
Main Results:
- Females exhibited lower peak kPCD, longer Tmax, lower AUC, and longer BT t ½ compared to males.
- Pre-pubertal children showed higher peak kPCD and AUC than peri- and post-pubertal children.
- Healthy children demonstrated faster gastric emptying (shorter BT t ½ and Tmax) than children with GLS. Normative reference values were established for females, and an algorithm showed 80.8% sensitivity for gastroparesis diagnosis.
Conclusions:
- Significant sex and pubertal variations in gastric emptying exist in children.
- This study provides the first reference values for gastric emptying in female children.
- The findings aid in the diagnosis of pediatric gastroparesis.
Introduction:
Diagnosing pediatric gastroparesis presents a significant challenge due to lack of normative data in children. We aimed to determine normative values for gastric emptying using the nonradioactive 13 C-Spirulina gastric emptying breath test ( 13 C-GEBT) in a large cohort of healthy children (HC) and examine differences compared to children with gastroparesis-like symptoms (GLS).
Methods:
A total of 301 HC ages 7-18 years completed the 13 C-GEBT with 10 different breath samples × 4 hours. 13 CO 2 excretion rate (kPCD) was determined by change in 13 CO 2 / 12 CO 2 . Outcome variables included: kPCD at 10 time points, peak (maximum) kPCD, time to peak (T max ) kPCD, and area under curve (AUC) of 13 CO 2 excretion, along with breath test half emptying time (BT t ½ ). Results were compared with 13 C-GEBT data from peripubertal and postpubertal patients 11-18 years of age with GLS.
Results:
A total of 216 HC, 51.4% female, completed the test meal within the allotted time. Females vs. males had lower peak kPCD ( P = 0.003), longer T max ( P = 0.04), lower AUC ( P < 0.001), and longer BT_t ½ ( P < 0.0001). Peak kPCD ( P = 0.01, P < 0.001) and AUC ( P = 0.012, P < 0.001) were higher in prepubertal vs peri pubertal and postpubertal children. BT_t ½ and T max were shorter in HC vs. GLS ( P < 0.001, P < 0.0001, respectively), consistent with faster gastric emptying in HC. Normative reference values based on 5th percentile kPCD and T max were established for peripubertal and postpubertal females. An algorithm incorporating key variables demonstrated 80.8% sensitivity for diagnosis of gastroparesis.
Discussion:
This study demonstrates sex and pubertal differences in gastric emptying in children and provides the first reference values for female children.
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