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De Keukelaere M, Carbone F, van Hoeve K, Tack J, Hoffman I. Nausea is the only symptom associated with delayed gastric emptying in pediatric functional dyspepsia patients. Neurogastroenterol Motil 2023; 35:e14620. [PMID: 37288616 DOI: 10.1111/nmo.14620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/25/2023] [Accepted: 05/17/2023] [Indexed: 06/09/2023]
Abstract
OBJECTIVES Functional dyspepsia (FD) is a heterogeneous functional gastrointestinal disorder (FGID) with a highly prevalent symptom complex. The aim of our study is to investigate the relation between symptoms of FD and results of gastric emptying (GE) breath test in children. METHODS This study included patients (6-17 years old) presented at the general gastroenterology outpatient clinic with dyspeptic symptoms (Rome IV criteria) and underwent careful history taking with clinical examination. A GE breath test with a 13 C-octanoic acid labeled (250 kcal) solid meal was performed and dyspepsia symptom scores, clarified using pictograms for postprandial fullness, bloating, belching, nausea, vomiting, epigastric pain and burning, were obtained every 15 min ranging from 0 to 4 for a total of 240 min. The severity of the complaints (overall and individual symptoms) as displayed by the symptom questionnaire was compared between normal and delayed GE groups. The relationship between GE time and the severity of FD symptoms was assessed using Mann-Whitney test. RESULTS Thirty nine FD patients (55% girls; mean age: 11.9 ± 3.3 years) participated in the study. Of these, 43% had delayed GE. The overall symptom severity in patients with delayed GE was similar to the symptoms of patients with a normal GE rate (149.5 ± 12.7 points vs. 123.9 ± 9.0; p = 0.19). Individual symptoms scores showed only nausea to be significantly increased in the group with delayed GE (21.5 ± 1.9 points vs. 33.2 ± 4.6; p = 0.048, p < 0.1). CONCLUSION Especially in children with nausea as presenting symptom of FD, a low threshold should be withheld to perform a GE breath test.
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Affiliation(s)
- Marijke De Keukelaere
- Pediatric Department, Imelda Hospital Bonheiden and University Hospitals Leuven, Leuven, Belgium
| | - Florencia Carbone
- Gastroenterology and Hepatology Unit, University Hospitals Leuven, Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Karen van Hoeve
- Department of Pediatric gastroenterology, Hepatology and Nutrition, University Hospitals Leuven, Leuven, Belgium
| | - Jan Tack
- Gastroenterology and Hepatology Unit, University Hospitals Leuven, Leuven, Belgium
- Translational Research Center for Gastrointestinal Disorders (TARGID), University of Leuven, Leuven, Belgium
| | - Ilse Hoffman
- Department of Pediatric gastroenterology, Hepatology and Nutrition, University Hospitals Leuven, Leuven, Belgium
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Wollmer E, Ungell AL, Nicolas JM, Klein S. Review of paediatric gastrointestinal physiology relevant to the absorption of orally administered medicines. Adv Drug Deliv Rev 2022; 181:114084. [PMID: 34929252 DOI: 10.1016/j.addr.2021.114084] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/13/2021] [Accepted: 12/13/2021] [Indexed: 12/11/2022]
Abstract
Despite much progress in regulations to improve paediatric drug development, there remains a significant need to develop better medications for children. For the design of oral dosage forms, a detailed understanding of the specific gastrointestinal (GI) conditions in children of different age categories and how they differ from GI conditions in adults is essential. Several review articles have been published addressing the ontogeny of GI characteristics, including luminal conditions in the GI tract of children. However, the data reported in most of these reviews are of limited quality because (1) information was cited from very old publications and sometimes low quality sources, (2) data gaps in the original data were filled with textbook knowledge, (3) data obtained on healthy and sick children were mixed, (4) average data obtained on groups of patients were mixed with data obtained on individual patients, and (5) results obtained using investigative techniques that may have altered the outcome of the respective studies were considered. Consequently, many of these reviews draw conclusions that may be incorrect. The aim of the present review was to provide a comprehensive and updated overview of the available original data on the ontogeny of GI luminal conditions relevant to oral drug absorption in the paediatric population. To this end, the PubMed and Web of Science metadatabases were searched for appropriate studies that examined age-related conditions in the oral cavity, esophagus, stomach, small intestine, and colon. Maturation was observed for several GI parameters, and corresponding data sets were identified for each paediatric age group. However, it also became clear that the ontogeny of several GI traits in the paediatric population is not yet known. The review article provides a robust and valuable data set for the development of paediatric in vitro and in silico biopharmaceutical tools to support the development of age-appropriate dosage forms. In addition, it provides important information on existing data gaps and should provide impetus for further systematic and well-designed in vivo studies on GI physiology in children of specific age groups in order to close existing knowledge gaps and to sustainably improve oral drug therapy in children.
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Keller J, Hammer HF, Afolabi PR, Benninga M, Borrelli O, Dominguez-Munoz E, Dumitrascu D, Goetze O, Haas SL, Hauser B, Pohl D, Salvatore S, Sonyi M, Thapar N, Verbeke K, Fox MR. European guideline on indications, performance and clinical impact of 13 C-breath tests in adult and pediatric patients: An EAGEN, ESNM, and ESPGHAN consensus, supported by EPC. United European Gastroenterol J 2021; 9:598-625. [PMID: 34128346 PMCID: PMC8259225 DOI: 10.1002/ueg2.12099] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022] Open
Abstract
Introduction 13C‐breath tests are valuable, noninvasive diagnostic tests that can be widely applied for the assessment of gastroenterological symptoms and diseases. Currently, the potential of these tests is compromised by a lack of standardization regarding performance and interpretation among expert centers. Methods This consensus‐based clinical practice guideline defines the clinical indications, performance, and interpretation of 13C‐breath tests in adult and pediatric patients. A balance between scientific evidence and clinical experience was achieved by a Delphi consensus that involved 43 experts from 18 European countries. Consensus on individual statements and recommendations was established if ≥ 80% of reviewers agreed and <10% disagreed. Results The guideline gives an overview over general methodology of 13C‐breath testing and provides recommendations for the use of 13C‐breath tests to diagnose Helicobacter pylori infection, measure gastric emptying time, and monitor pancreatic exocrine and liver function in adult and pediatric patients. Other potential applications of 13C‐breath testing are summarized briefly. The recommendations specifically detail when and how individual 13C‐breath tests should be performed including examples for well‐established test protocols, patient preparation, and reporting of test results. Conclusion This clinical practice guideline should improve pan‐European harmonization of diagnostic approaches to symptoms and disorders, which are very common in specialist and primary care gastroenterology practice, both in adult and pediatric patients. In addition, this guideline identifies areas of future clinical research involving the use of 13C‐breath tests.
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Affiliation(s)
- Jutta Keller
- Department of Internal Medicine, Israelitic Hospital, Academic Hospital University of Hamburg, Hamburg, Germany
| | - Heinz F Hammer
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria
| | - Paul R Afolabi
- NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust and University of Southampton, Southampton, UK
| | - Marc Benninga
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Osvaldo Borrelli
- UCL Great Ormond Street Institute of Child Health and Department of Gastroenterology, Neurogastroenterology and Motility, Great Ormond Street Hospital, London, UK
| | - Enrique Dominguez-Munoz
- Department of Gastroenterology and Hepatology, University Hospital of Santiago de Compostela, Santiago, Spain
| | | | - Oliver Goetze
- Department of Medicine II, Division of Hepatology, University Hospital Würzburg, Würzburg, Germany
| | - Stephan L Haas
- Department of Upper GI Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Bruno Hauser
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, KidZ Health Castle UZ Brussels, Brussels, Belgium
| | - Daniel Pohl
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland
| | - Silvia Salvatore
- Pediatric Department, Hospital "F. Del Ponte", University of Insubria, Varese, Italy
| | - Marc Sonyi
- Department of Internal Medicine, Division of Gastroenterology and Hepatology, Medical University of Graz, Graz, Austria.,Clinic for General Medicine, Gastroenterology, and Infectious Diseases, Augustinerinnen Hospital, Cologne, Germany
| | - Nikhil Thapar
- UCL Great Ormond Street Institute of Child Health and Department of Gastroenterology, Neurogastroenterology and Motility, Great Ormond Street Hospital, London, UK.,Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Australia
| | - Kristin Verbeke
- Translational Research Center for Gastrointestinal Disorders, KU Leuven, Leuven, Belgium
| | - Mark R Fox
- Division of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.,Digestive Function: Basel, Laboratory and Clinic for Motility Disorders and Functional Gastrointestinal Diseases, Centre for Integrative Gastroenterology, Klinik Arlesheim, Arlesheim, Switzerland
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Kovacic K, Zhang L, Nugent Liegl M, Pawela L, Simpson P, Sood MR. Gastric emptying in healthy children using the Spirulina breath test: The impact of gender, body size, and pubertal development. Neurogastroenterol Motil 2021; 33:e14063. [PMID: 33300658 DOI: 10.1111/nmo.14063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/10/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are no pediatric norms for gastric emptying (GE) measured by nuclear scintigraphy. The 13 C-labeled, stable isotope GE breath test (GEBT) is a non-radioactive alternative. We aimed to determine normative GEBT ranges in a cohort of healthy children and examine the influence of age, gender, puberty, and body surface area (BSA). METHODS Healthy children ages 8-18 years completed the [13 C]-Spirulina platensis GEBT after an overnight fast. Breath samples were collected at baseline, every 15 min × 1 h, then every 30 min for 4 h total. The 13 CO2 excretion rate was determined by the change in 13 CO2 /12 CO2 over time in each breath sample, expressed as kPCD (Percent 13 C Dose excreted/min). A mixed model with random time was used for multivariable analysis and outcome fit into a quadratic model. KEY RESULTS The 100 subjects completed the test meal within allotted time. Median (IQR) age was 13.5 (11.3-15.5) years; 51% were female. Females had lower 13 CO2 excretion rates (slower GE) than males across time (p < 0.001) while decreased excretion rates correlated with higher BSA (p = 0.015). Gender differences were also noted within pubertal stages with females showing slower GE. Multivariable analysis suggested that pre-pubertal children have faster GE than both peri- and post-pubertal groups (p < 0.0001). CONCLUSIONS & INFERENCES Gender, puberty, and BSA influence GE rates in healthy children more than age. Although further data are needed, pubertal stage and hormonal influences may be unique factors to consider when assessing GE in children.
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Affiliation(s)
- Katja Kovacic
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liyun Zhang
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melodee Nugent Liegl
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louis Pawela
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manu R Sood
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
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Keller J, Hammer HF, Hauser B. 13 C-gastric emptying breath tests: Clinical use in adults and children. Neurogastroenterol Motil 2021; 33:e14172. [PMID: 33998745 DOI: 10.1111/nmo.14172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/27/2021] [Indexed: 12/28/2022]
Abstract
13 C-gastric emptying breath tests (13 C-GEBT) are validated, reliable, and non-invasive tools for measurement of gastric emptying (GE) velocity of solids and liquids without radiation exposure or risk of toxicity. They are recommended and routinely used for clinical purposes in adult as well as pediatric patients and can be readily performed onsite or even at the patient's home. However, the underlying methodology is rather complex and test results can be influenced by dietary factors, physical activity, concurrent diseases, and medication. Moreover, epidemiological factors can influence gastric emptying as well as production and exhalation of 13 CO2 , which is the ultimate metabolic product measured for all 13 C-breath tests. Accordingly, in this issue of Neurogastroenterology & Motility, Kovacic et al. report performance of the 13 C-Spirulina breath test in a large group of healthy children and show significant effects of gender, pubertal status, and body size on test results. The purpose of this mini-review is to evaluate the clinical use of 13 C-GEBT in adults and children, exploring available protocols, analytical methods, and essential prerequisites for test performance, as well as the role of GE measurements in the light of the current discussion on relevance of delayed GE for symptom generation.
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Affiliation(s)
- Jutta Keller
- Department of Internal Medicine, Israelitic Hospital, Academic Hospital University of Hamburg, Hamburg, Germany
| | - Heinz F Hammer
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Bruno Hauser
- Department of Paediatric Gastroenterology, Hepatology and Nutrition, KidZ Health Castle UZ Brussel, Brussels, Belgium
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Geyer MC, Rayner CK, Horowitz M, Couper JJ. Targeting postprandial glycaemia in children with diabetes: Opportunities and challenges. Diabetes Obes Metab 2018; 20:766-774. [PMID: 29072820 DOI: 10.1111/dom.13141] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 10/02/2017] [Accepted: 10/21/2017] [Indexed: 02/05/2023]
Abstract
Postprandial glycaemia makes a substantial contribution to overall glycaemic control in diabetes, particularly in patients whose preprandial glycaemia is relatively well controlled and glycated haemoglobin (HbA1c) only modestly elevated. Our review addresses the determinants of postprandial glycaemia and how it may be targeted therapeutically in children with diabetes. Postprandial glycaemia is influenced by preprandial glycaemia, macronutrients and their absorption, insulin delivery and sensitivity, the action of the enteroendocrine system, and the rate of gastric emptying. Contemporary continuous glucose monitoring systems reveal patterns of post prandial glycaemia and allow management to be guided more precisely. Delays in blood glucose determination, insulin delivery and its absorption remain challenges in the rapidly evolving closed loop continuous subcutaneous insulin and glucagon delivery systems developed for children with type 1 diabetes. Augmentation of the incretin system through nutritional preloads or incretin mimetics targets postprandial glycaemia by slowing gastric emptying as well as insulinotropic and glucagonostatic effects. These treatments are of particular relevance to children with type 2 diabetes. Following the development of targeted therapies in adults, postprandial blood glucose control will now be increasingly targeted in the treatment of diabetes in children.
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Affiliation(s)
- Myfanwy C Geyer
- Discipline of Paediatrics, University of Adelaide, Adelaide, Australia
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, Australia
| | - Christopher K Rayner
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Michael Horowitz
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
- Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, Australia
| | - Jennifer J Couper
- Department of Endocrinology and Diabetes, Women's and Children's Hospital, Adelaide, Australia
- Robinson Research Institute, University of Adelaide, Adelaide, Australia
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Franken J, Mauritz FA, Stellato RK, Van der Zee DC, Van Herwaarden-Lindeboom MYA. The Effect of Gastrostomy Placement on Gastric Function in Children: a Prospective Cohort Study. J Gastrointest Surg 2017; 21:1105-1111. [PMID: 28424983 PMCID: PMC5486691 DOI: 10.1007/s11605-017-3376-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND A gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. Unfortunately, postoperative complications such as leakage, feeding intolerance, and gastroesophageal reflux frequently occur. These complications may be due to postoperative gastric dysmotility. Our aim was to evaluate the effect of gastrostomy placement on gastric emptying in children. METHODS A prospective study was performed including 50 children undergoing laparoscopic gastrostomy. Before and 3 months after gastrostomy, assessment was performed using the 13C-octanoic acid breath test, 24-h pH monitoring, and reflux symptom questionnaires. RESULTS Gastric half-emptying time significantly increased from the 57th to the 79th percentile (p < 0.001) after gastrostomy (p < 0.001). Fifty percent of patients with normal preoperative gastric emptying develop delayed gastric emptying (DGE, P > 95) after gastrostomy (p = 0.01). Most patients (≥75%) with leakage and/or feeding intolerance after gastrostomy had DGE after operation. A decrease in gastric emptying was associated with an increase in esophageal acid exposure time (r = 0.375, p < 0.001). CONCLUSION Gastrostomy placement in children causes a significant delay in gastric emptying. Postoperative DGE was associated with gastroesophageal reflux and was found in most patients with postoperative leakage and feeding intolerance. These negative physiologic effects should be taken into account when considering gastrostomy placement in children.
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Affiliation(s)
- Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands.
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
- Department of Gastroenterology and Hepatology, Wilhelmina Children's Hospital, Utrecht, The Netherlands
| | - Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - David C Van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
| | - Maud Y A Van Herwaarden-Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Room KE.04.140.5, PO Box 85090, 3508 AB, Utrecht, The Netherlands
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Husnik R, Fletcher JM, Gaschen L, Gaschen FP. Validation of Ultrasonography for Assessment of Gastric Emptying Time in Healthy Cats by Radionuclide Scintigraphy. J Vet Intern Med 2017; 31:394-401. [PMID: 28220541 PMCID: PMC5354052 DOI: 10.1111/jvim.14674] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 11/23/2016] [Accepted: 01/16/2017] [Indexed: 12/16/2022] Open
Abstract
Background The prevalence of gastric emptying (GE) disorders in cats is unknown due to lack of clinically applicable diagnostic tests. Objectives The principal aim of this study was to assess correlation between scintigraphic and ultrasonographic measurements of GE time (GET) in healthy cats. Additionally, variability of ultrasonographic GET, and correlation between scintigraphy and ultrasonographic parameters of gastric motility were evaluated. Animals Eight healthy domestic shorthair cats. Methods Prospective study. Scintigraphic GET was determined using a solid test meal containing 4 mCi 99mTc‐mebrofenin. Each cat had 3 separate ultrasonographic assessments of GE, performed independent of scintigraphic assessment, after solid test meal consumption. The motility index (MI) of antral contractions was plotted against time and time for each fraction of the area under the MI curve determined. Ultrasonographic GET and MI were correlated to scintigraphic GET. Results Scintigraphic GET (mean ± SD) for 25, 50, and 75% GE was 103 ± 32 minutes, 196 ± 45 minutes, and 288 ± 62 minutes, whereas sonographic GET for 25, 50, and 75% GE was 106 ± 13 minutes, 203 ± 19 minutes, and 305 ± 27 minutes. There was good correlation between scintigraphic and sonographic GET (r = 0.72–0.82) at 45–90% fractional GE and between scintigraphic GET and time of corresponding MI curve fraction (r = 0.78–0.86) at 40–90% fraction of the MI curve. There was moderate intraindividual variability for sonographic GET and MI curve fraction times as well as significant variation among individuals. Conclusions and clinical importance Ultrasonography is a valid alternative to scintigraphy for assessment of solid‐phase GE and allows assessment of postprandial gastric motility in healthy cats.
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Affiliation(s)
- R Husnik
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - J M Fletcher
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - L Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
| | - F P Gaschen
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA
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Hauser B, Roelants M, De Schepper J, Veereman G, Caveliers V, Devreker T, De Greef E, Vandenplas Y. Gastric emptying of solids in children: reference values for the (13) C-octanoic acid breath test. Neurogastroenterol Motil 2016; 28:1480-7. [PMID: 27098977 DOI: 10.1111/nmo.12845] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Accepted: 03/30/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND (99m) Technetium scintigraphy ((99m) TS) is the 'gold standard' for measuring gastric emptying (GE), but it is associated with a radiation exposure. For this reason, the (13) C-octanoic acid breath test ((13) C-OBT) was developed for measuring GE of solids. The objective of this study was to determine normal values for gastric half-emptying time (t1/2 GE) of solids in healthy children. METHODS Gastric emptying of a standardized solid test meal consisting of a pancake evaluated with (99m) TS and (13) C-OBT was compared in 22 children aged between 1 and 15 years with upper gastrointestinal symptoms. Subsequently, the (13) C-OBT was used to determine normal values for GE of the same solid test meal in 120 healthy children aged between 1 and 17 years. KEY RESULTS The results showed a significant correlation (r = 0.748, p = 0.0001) between t1/2 GE measured with both techniques in the group of children with upper gastrointestinal symptoms. In the group of healthy children, mean t1/2 GE was 157.7 ± 54.0 min (range 71-415 min), but t1/2 GE decreased with age between 1 and 10 years and remained stable afterward. There was no influence of gender, weight, height, body mass index, and body surface area on t1/2 GE. CONCLUSIONS & INFERENCES Normal values for GE of solids measured with the (13) C-OBT using a standardized methodology were determined in healthy children. We propose to use this method and corresponding reference ranges to study GE of solids in children with gastrointestinal problems.
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Affiliation(s)
- B Hauser
- Department of Paediatrics, Universitair Kinderziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium.
| | - M Roelants
- Department of Public Health and Primary Care, Katholieke Universiteit Leuven, Leuven, Belgium
| | - J De Schepper
- Department of Paediatrics, Universitair Kinderziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - G Veereman
- Department of Paediatrics, Universitair Kinderziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - V Caveliers
- Department of Nuclear Medicine, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - T Devreker
- Department of Paediatrics, Universitair Kinderziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - E De Greef
- Department of Paediatrics, Universitair Kinderziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
| | - Y Vandenplas
- Department of Paediatrics, Universitair Kinderziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, Belgium
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Keller J, Binnewies U, Rösch M, Juul Holst J, Beglinger C, Andresen V, Layer P. Gastric emptying and disease activity in inflammatory bowel disease. Eur J Clin Invest 2015; 45:1234-42. [PMID: 26426315 DOI: 10.1111/eci.12542] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 09/25/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Gastric emptying (GE) is delayed in a subset of patients with inflammatory bowel disease (IBD). We have shown before that altered release of gastrointestinal hormones may contribute to GE disturbances, but overall effects of disease activity remain unclear. Thus, we aimed to evaluate GE in patients with IBD during active disease and following therapy. DESIGN A total of 20 healthy subjects (HC) and 26 patients with IBD hospitalized because of an acute episode of their disease (Crohn's disease (CD) n = 13, ulcerative colitis (UC) n = 13) underwent a standardized (13) C-octanoic acid GE breath test (baseline test). Plasma glucose, cholecystokinin (CCK), peptide YY (PYY) and glucagon-like peptide-1 (GLP-1) were measured periodically throughout the test. A total of 16 patients underwent a second GE test after 3-4 months of therapy. RESULTS At baseline, nine patients with IBD had pathologically delayed GE half-time (T½ > 150 min) (P = 0·028 vs. HC). Moreover, T½ was significantly longer in the total group of patients with IBD than in HC (129 ± 12 min vs. 96 ± 7, P = 0·030). Postprandial GLP-1 responses were elevated in IBD (P = 0·002 vs. HC) and correlated with T½ (P = 0·05). Following therapy clinical activity indices and T½ were decreased in IBD (P ≤ 0·01 vs. baseline), and T½ no longer differed from HC (P > 0·5). Moreover, GLP-1 plasma levels decreased significantly (P = 0·031). CONCLUSIONS Higher disease activity in IBD is associated with prolonged GE and increased release of GLP-1. Following effective therapy, GE is accelerated and GLP-1 release decreases significantly. Thus, increased release of GLP-1 from the inflamed mucosa might contribute to GE disturbances in IBD.
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Affiliation(s)
- Jutta Keller
- Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany
| | - Ulrich Binnewies
- Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany
| | - Marie Rösch
- Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany
| | - Jens Juul Holst
- NNF Center for Basic Metabolic Research and Department of Biomedical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christoph Beglinger
- Department of Gastroenterology and Hepatology, Universitätsspital Basel, Basel, Switzerland
| | - Viola Andresen
- Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany
| | - Peter Layer
- Department of Internal Medicine, Israelitic Hospital, Hamburg, Germany
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Perano SJ, Rayner CK, Kritas S, Horowitz M, Donaghue K, Mpundu-Kaambwa C, Giles L, Couper JJ. Gastric Emptying Is More Rapid in Adolescents With Type 1 Diabetes and Impacts on Postprandial Glycemia. J Clin Endocrinol Metab 2015; 100:2248-53. [PMID: 25871840 DOI: 10.1210/jc.2015-1055] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
CONTEXT Gastric emptying is a critical determinant of postprandial glycemic control in health and type 1 diabetes. There are few studies that assess the relationship between gastric emptying and postprandial glycaemia in adolescents with type 1 diabetes. OBJECTIVE The objectives of the study were to quantify gastric emptying in adolescents with type 1 diabetes and examine its relationship to postprandial glycaemia and autonomic function. DESIGN This was a case-control study. Gastric half-emptying time of a solid meal was measured by a (13)C-octanoate breath test. Cardio-autonomic function was measured by heart rate variability. Chronic and postprandial gastrointestinal symptoms were evaluated by questionnaire and visual analog scales. Blood glucose concentrations were monitored frequently during the study. SETTING The study was conducted at a tertiary pediatric hospital in South Australia. PARTICIPANTS Thirty adolescents (aged 15 ± 2.5 y) with type 1 diabetes and age- and sex-matched controls (gastric emptying, n = 20; heart rate variability, n = 135) participated in the study. MAIN OUTCOME Gastric half-emptying time was the main outcome in the study. RESULTS Gastric emptying was more rapid in subjects with type 1 diabetes than controls [median half emptying time 78 (interquartile range 61-99) vs 109 (interquartile range 71-124) min, P = .02]. The postprandial rise in blood glucose at 60 minutes was strongly related to gastric half-emptying time (R = -0.65, P = .0001). Gastric emptying was slower in subjects with fasting hyperglycemia but was not related to heart rate variability. Nausea, bloating, and anxiety were related to fasting glycemia (P = .03). CONCLUSION Rapid gastric emptying is a major determinant of postprandial glycemia in adolescents with type 1 diabetes. This observation has significant implications for therapy.
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Affiliation(s)
- Shiree J Perano
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Chris K Rayner
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Stamatiki Kritas
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Michael Horowitz
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Kim Donaghue
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Christine Mpundu-Kaambwa
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Lynne Giles
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
| | - Jenny J Couper
- Departments of Diabetes and Endocrinology (S.J.P., J.J.C.) and Gastroenterology (S.K.), and Research and Evaluation Unit (C.M.-K.), Women's and Children's Hospital, Adelaide, South Australia 5006, Australia; Robinson Research Institute and School of Paediatrics and Reproductive Health (S.J.P., J.J.C.), Discipline of Medicine (C.K.R., M.H.), and School of Population Health (L.G.), University of Adelaide, and Department of Gastroenterology and Hepatology (C.K.R.) and Endocrine and Metabolic Unit (M.H.), Royal Adelaide Hospital, Adelaide, South Australia 5000, Australia; and Institute of Endocrinology (K.D.), Children's Hospital Westmead, Westmead, New South Wales 2145, Australia
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Ersoy B, Sayit E, Can S, Urk V, Batok D, Polat M. Gastric emptying of solids and its relationship with microalbuminuria in children and adolescents with type 1 diabetes mellitus. J Diabetes 2013; 5:319-24. [PMID: 23534498 DOI: 10.1111/1753-0407.12051] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Revised: 03/21/2013] [Accepted: 03/25/2013] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The aims of the present study were to determine the frequency of delayed gastric emptying in children and adolescents with type 1 diabetes mellitus (T1DM) and to investigate the relationship between gastric emptying rate and other contributing factors (e.g. serum HbA1c, duration of diabetes and microalbuminuria) in these patients. METHODS This was a clinical trial evaluating the rate of gastric emptying of solid meals in 33 children and adolescents with T1DM and in 26 healthy peers using a radionuclide method. Three consecutive overnight urine collections were used to calculate the albumin excretion rate. RESULTS There was no significant difference in the gastric half-emptying time (GE t½ ) between patients and controls (151.7 ± 154.5 vs 109.8 ± 60.5 min, respectively; P=0.885) or the frequency of delayed gastric emptying (36.4% vs 30.8%, respectively; P=0.433). There was a moderately positive correlation between GE t½ and the duration of diabetes (r=0.380; P=0.029). There was no correlation between GE t½ and microalbumin levels in T1DM patients. In these patients, the body mass index standard deviation scores were significantly lower than in patients with normal gastric emptying (-0.13 ± 0.87 vs 0.7 ± 1.23, respectively; P=0.044). CONCLUSION Progression of delayed gastric emptying is more likely to be related to a longer duration of diabetes than glycemic control in children and adolescents with T1DM. Patients with delayed gastric emptying are thinner compared with patients with a normal rate of gastric emptying; they may also be asymptomatic.
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Affiliation(s)
- Betul Ersoy
- Division of Pediatric Endocrinology and Metabolism, Celal Bayar University, School of Medicine, Manisa, Turkey.
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Ballauff A, Wenzl TG, Bialek R, Witt H, Naim HY. Funktions- und Laboruntersuchungen. PÄDIATRISCHE GASTROENTEROLOGIE, HEPATOLOGIE UND ERNÄHRUNG 2013. [PMCID: PMC7498812 DOI: 10.1007/978-3-642-24710-1_3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Zur Analyse abgeatmeter Gase muss endexspiratorische Luft gewonnen werden, ohne Vermischung mit frühexspiratorischer Luft (sonst Korrektur mit Messung des CO2-Partialdrucks, s. unten). Ältere Kinder blasen nach Anhalten der Atmung über 15 s durch tiefe Ausatmung über einen Strohhalm endexspiratorische Luft in ein Glasröhrchen, das dann luftdicht verschlossen wird (Vacutainer), oder über ein Mundstück oder eine Maske direkt in ein H2-Messgerät oder in Beutel. Bei Säuglingen und Kleinkindern kann mit einer Maske oder einer Sonde, die bis zum nasopharyngealen Übergang vorgeschoben wird, mit einer Spritze atemsynchron exspiratorische Luft abgesaugt und in Vacutainer oder direkt in das Messgerät eingegeben werden. In Vacutainern sind Proben über mehr als 30 Tage stabil und können auch zur Analyse verschickt werden.
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Boillat CS, Gaschen FP, Gaschen L, Stout RW, Hosgood GL. Variability associated with repeated measurements of gastrointestinal tract motility in dogs obtained by use of a wireless motility capsule system and scintigraphy. Am J Vet Res 2010; 71:903-8. [PMID: 20673089 DOI: 10.2460/ajvr.71.8.903] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare repeatability of measurements of gastrointestinal tract motility in healthy dogs obtained by use of a wireless motility capsule (WMC) and scintigraphy. ANIMALS 6 healthy adult dogs (mean +/- SD body weight, 21.5 +/- 1.8 kg). PROCEDURES A radiolabeled test meal was offered immediately after oral administration of a WMC. Serial static scintigraphic abdominal images were acquired for 270 minutes. A dedicated remote receiver was used for data collection from the WMC until the WMC was expelled in the feces. Each dog was evaluated 3 times at intervals of 1 to 2 weeks. RESULTS Mean gastric emptying half-time measured by use of scintigraphy (T(1/2)-GES) for each dog ranged from 99.9 to 181.2 minutes. Mean gastric emptying time (GET) measured by use of the WMC (GET-WMC) in each dog ranged from 385.3 to 669.7 minutes. Mean coefficient of variation was 11.8% for T(1/2)-GES and 7.8% for GET-WMC. The intraclass correlation coefficient was 69% for T(1/2)-GES and 71% for GET-WMC. Results for a nested analysis of covariance suggested that both methods were comparable for the evaluation of gastric emptying. CONCLUSIONS AND CLINICAL RELEVANCE Scintigraphy and a WMC system had similar variation for assessment of gastric emptying. Moderate intraindividual variability was detected for both methods and must be considered when interpreting test results for individual dogs. Repeatability of measurements obtained by use of the WMC was equivalent to that obtained by use of scintigraphy. The WMC system offers a nonradioactive, user-friendly method for assessment of gastric emptying in dogs.
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Affiliation(s)
- Carol S Boillat
- Department of Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA 70803, USA
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Clegg ME, Shafat A. Procedures in the 13C octanoic acid breath test for measurement of gastric emptying: analysis using Bland-Altman methods. Scand J Gastroenterol 2010; 45:852-61. [PMID: 20443742 DOI: 10.3109/00365521.2010.483740] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The (13)C octanoic acid breath test (OBT) was first developed as an alternative method of measuring gastric emptying (GE) to scintigraphy. There has been much debate about the test duration and how often measurements need to be taken. This study aims to address these issues. MATERIAL AND METHODS For 78 GE tests using the (13)C OBT, GE lag phase (T(lag)) was calculated while sampling more frequently than the recommended every 15 min. Comparisons between T(lag) were completed using Bland-Altman plots. Similarly, 4 or 6 h test durations were assessed to establish if they yield the same GE half time (T(half)). From one volunteer, samples were taken every 1 min for the first 30 min and then every 15 min until 6 h. GE times were then calculated using different combinations of sampling times. Evidence of a visible T(lag) was also explored from this data. RESULTS Findings indicated that taking samples every 5 min for the first 30 min instead of every 15 min did not change the GE T(lag) based on Bland-Altman plots. The correlation between these two methods was also high (r(2) = 0.9957). The findings showed that the difference between the two sampling durations 4 and 6 h was large and the correlation between the methods was low (r(2) = 0.8335). Samples taken at a rate of one breath per min indicated lack of a visible T(lag). CONCLUSIONS Sampling for the (13)C OBT should be completed every 15 min for 6 h.
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Affiliation(s)
- Miriam E Clegg
- Functional Food Centre, School of Life Sciences, Oxford Brookes University, Oxford, UK.
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Breath tests in pediatrics. Clin Chim Acta 2008; 397:1-12. [DOI: 10.1016/j.cca.2008.07.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 07/22/2008] [Accepted: 07/22/2008] [Indexed: 12/19/2022]
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Cloetens L, Swennen K, De Preter V, Broekaert WF, Courtin CM, Delcour JA, Rutgeerts P, Verbeke K. Effect of arabinoxylo-oligosaccharides on proximal gastrointestinal motility and digestion in healthy volunteers. ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.eclnm.2008.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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HATTORI Y, MITO Y, WATANABE M. Gastric emptying rate in subjects with experimentally shortened dental arches: a pilot study. J Oral Rehabil 2008; 35:402-7. [DOI: 10.1111/j.1365-2842.2007.01789.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Gastric emptying of solids is slower in functional dyspepsia unrelated to Helicobacter pylori infection in female children and teenagers. J Pediatr Gastroenterol Nutr 2008; 46:403-8. [PMID: 18367952 DOI: 10.1097/mpg.0b013e318159224e] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
AIM To evaluate gastric emptying of solids in children and adolescents with functional dyspepsia with and without Helicobacter pylori infection. PATIENTS AND METHODS The study included 27 female patients (mean age 13.38 +/- 2.81 y) with functional dyspepsia according to Rome II criteria who were selected after upper gastrointestinal endoscopy found no major mucosal abnormality. Fragments were collected from the esophagus, gastric antrum, and gastric body for histological examination and rapid urease test. H. pylori infection was diagnosed according to the rapid urease test and histological appearance. The histological appearance of the gastric mucosa was evaluated according to modified Sydney criteria. A C-octanoic breath test was performed after a test meal (2 slices of toasted bread, 10 g margarine, and 1 egg with 100 microL of the tracer dipped in the yolk) with 13 points of air collection in 4 hours. RESULTS Infection with H. pylori was observed in 12 of 27 patients (44.4%). The gastric emptying half-time was shorter in infected patients than in uninfected patients (mean +/- SD 153.4 +/- 20.0 min vs 179.2 +/- 32.2 min; P = 0.019), as was the lag phase (106.3 +/- 22.6 vs 126.6 +/- 22.7 min; P = 0.038). There was no relationship between gastric emptying (half-time and lag phase) and degree of histological abnormality. Vomiting and nausea were associated with slower gastric emptying in patients without H. pylori gastritis more often than in infected patients. CONCLUSIONS The study suggests that delayed gastric emptying can play an important role in a subgroup of dyspeptic patients, particularly those without H. pylori infection who have nausea and vomiting.
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