GASTRIC-EMPTYING IN CHILDREN WITH GASTRIC TRANSPOSITION

Using the noninvasive technique of electrical impedance tomography (EIT), gastric emptying was studied in 12 children, aged 9 months to 17 years, who had undergone gastric transposition (six with pyloroplasty) for oesophageal replacement (seven oesophageal atresia, five severe caustic or peptic damage). In two patients, gastric antral electrical control activity was also studied using surface electrogastrography. Nine patients had problems on oral feeds (respiratory symptoms, feeding difficulties, vomiting, abdominal pain, symptoms suggesting dumping), whilst three were asymptomatic. All 12 patients were tested with a milk meal; in addition four (two with and two without dumping symptoms) were tested with a hypertonic glucose drink; gastric emptying of the milk meal was expressed as the percentage of the meal remaining in the stomach at 60 min (R60). Mean (+/-2 SD) R60 was 54.6% (+/-17.4%) in 12 healthy controls and 59.8% (+/-83.2%) in the 12 patients. Gastric emptying was normal in one patient (R60, 42.6%), delayed in seven (mean R60, 91.2%; range, 74.4-100%), and accelerated in four (R60, 0%). The emptying rate was unrelated to the presence or absence of pyloroplasty. Furthermore, the emptying pattern was extremely irregular, suggesting that gastroesophageal as well as duodenogastric reflux episodes occurred in all patients. The hypertonic glucose drink induced dumping (50% of the meal emptied at 1-3 min) in all four patients, two of whom had delayed emptying of the milk meal, but the gastric antral electrical control activity occurred at the normal frequency of 0.05 Hz. The transposed stomach does not behave as a simple conduit; in most cases it retains its reservoir function. Irrespective of the patient's symptoms, the transposed stomach empties in an abnormal fashion, and the composition of the meal may considerably affect the emptying pattern.