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Delayed gastric emptying in infants with gastroesophageal reflux
Insights
Infants with severe gastroesophageal reflux (GER) experience significantly delayed gastric emptying. This gastric retention may contribute to failure to thrive and pulmonary issues in infants with GER.
Area of Science:
- Pediatric Gastroenterology
- Infant Nutrition
- Digestive Physiology
Background:
- Gastroesophageal reflux (GER) is common in infants.
- The relationship between GER severity and gastric emptying is not fully understood.
- Delayed gastric emptying may contribute to complications like failure to thrive (FTT) and pulmonary symptoms.
Purpose of the Study:
- To investigate the rate of gastric emptying in infants with symptomatic gastroesophageal reflux (GER) of varying intensity.
- To explore the potential role of delayed gastric emptying in the pathogenesis of GER in infancy.
Main Methods:
- Twenty-three infants (2-14 months) underwent evaluation for GER using esophageal manometry, 5-hour pH probe studies, and barium swallow.
- Gastric emptying was assessed using a liquid formula meal labeled with 99mTc sulfur colloid.
- Comparison groups included infants with severe GER, mild GER, and healthy adults.
Main Results:
- Infants with severe GER showed significantly delayed gastric emptying (21.3% at 1 hour) compared to those with mild GER (44.3% at 1 hour) and healthy adults (56.2% at 1 hour).
- Infants with GER and recurrent pulmonary disease had delayed gastric emptying (19.8% at 1 hour).
- Infants with severe GER and failure to thrive (FTT) also demonstrated delayed gastric emptying.
Conclusions:
- Severe gastroesophageal reflux (GER) in infants is associated with significantly delayed gastric emptying.
- Gastric retention may be a contributing factor to failure to thrive (FTT) and pulmonary complications in infants with GER.
- Abnormal gastric fundal motor function may play a significant role in the development of infant GER.
Abstract:
The purpose of this study was to investigate the rate of gastric emptying of a liquid meal in young children with symptomatic gastroesophageal reflux of varying intensity. Twenty-three infants (mean age 7.0 +/- 1.4 [SEM] months, range 2 to 14 months) were evaluated for reflux by esophageal manometry, a five-hour pH probe study, and barium swallow. The rate of gastric emptying was determined by using a liquid meal of 4 ounces of cow milk formula labeled with 99mTc sulfur colloid. In seven infants with failure to thrive and objective criteria for severe reflux, the mean gastric emptying was 21.3 +/- 6.4% at one hour. In six infants with reflux and recurrent pulmonary disease, the mean gastric emptying was 19.8 +/- 5.4%. Ten infants with mild reflux, adequate weight gain, and no pulmonary symptoms emptied 44.3 +/- 6.0% of formula at one hour, and six normal adults (mean age 28.3 +/- 2 years) emptied 56.2 +/- 6.5% of formula at one hour. These data suggest that infants with severe GER have significantly delayed gastric emptying, that gastric retention may contribute to the FTT and pulmonary symptoms in these infants, and that abnormal motor function of the gastric fundus may be a significant factor in the pathogenesis of gastroesophageal reflux of infancy.