GASTRIC-EMPTYING IN CHILDREN WITH GASTRIC TRANSPOSITION

Using the noninvasive technique of electrical impedance tomography (EI T), gastric emptying was studied in 12 children, aged 9 months to 17 y ears, who had undergone gastric transposition (six with pyloroplasty) for oesophageal replacement (seven oesophageal atresia, five severe ca ustic or peptic damage). In two patients, gastric antral electrical co ntrol activity was also studied using surface electrogastrography. Nin e patients had problems on oral feeds (respiratory symptoms, feeding d ifficulties, vomiting, abdominal pain, symptoms suggesting dumping), w hilst three were asymptomatic. All 12 patients were tested with a milk meal; in addition four (two with and two without dumping symptoms) we re tested with a hypertonic glucose drink; gastric emptying of the mil k meal was expressed as the percentage of the meal remaining in the st omach at 60 min (R60). Mean (+/-2 SD) R60 was 54.6% (+/-17.4%) in 12 h ealthy controls and 59.8% (+/-83.2%) in the 12 patients. Gastric empty ing 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 emp tying rate was unrelated to the presence or absence of pyloroplasty. F urthermore, the emptying pattern was extremely irregular, suggesting t hat gastroesophageal as well as duodenogastric reflux episodes occurre d in all patients. The hypertonic glucose drink induced dumping (50% o f the meal emptied at 1-3 min) in all four patients, two of whom had d elayed emptying of the milk meal, but the gastric antral electrical co ntrol activity occurred at the normal frequency of 0.05 Hz. The transp osed stomach does not behave as a simple conduit; in most cases it ret ains its reservoir function. Irrespective of the patient's symptoms, t he transposed stomach empties in an abnormal fashion, and the composit ion of the meal may considerably affect the emptying pattern.