Location: Children's Nutrition Research CenterTitle: Concomitant gastroparesis occurs in functional gallbladder disease and may negatively impact clinical outcome) Author
Submitted to: Gastroenterology
Publication Type: Abstract Only
Publication Acceptance Date: 4/1/2009
Publication Date: 5/1/2009
Citation: Chumpitazi, B.P., Malowitz, S.M., Gopalakrishna, G.S., Shulman, R.J. 2009. Concomitant gastroparesis occurs in functional gallbladder disease and may negatively impact clinical outcome [abstract]. Gastroenterology. 136(5 Suppl.1):A512. Interpretive Summary:
Technical Abstract: Functional gallbladder disease, commonly known as Biliary Dyskinesia (BD), is an increasingly recognized cause of chronic abdominal pain and dyspepsia in adults and children. Similar symptoms may occur in those with Gastroparesis (GP). The potential role and impact of concomitant GP in those with BD has not been examined formally. To determine if GP and BD occurs concomitantly, and if so, to determine if GP influences clinical outcome in those with BD. Retrospective chart review of children with BD (ejection fraction <35% on CCK-HIDA scan, with no other metabolic, or structural cause) and a solid-phase gastric emptying scan (GES) within 12 months of the abnormal CCK-HIDA scan. Those with documented follow-up after both scintigraphic evaluations were included. Clinical outcomes were categorized into four groups (poor, fair, good, excellent), based on symptom status at follow-up as compared to baseline. Those with activity limitation (e.g. school absences) due to dyspepsia at follow-up were classified as doing poorly, 35 children met the inclusion criteria. Twenty of 35 (57%) had a delayed GES. Mean CCK-HIDA ejection fraction did not differ between those with normal or delayed GES (15.9% ± 3.1 (SE) vs. 14.4% ± 2.8, respectively.) Age, gender, BMI%, and usage of antacids, analgesics, and neuromodulators did not differ between those with normal or delayed GES. Children with delayed GES (14/20 versus 4/15) were more likely to have used a prokinetic (P<0.05). Rapid emptying on GES was not found in any patient. Subjects were followed for a mean of 23.1 ± 2.9 months. Clinical outcome based on GES result in those with BD is found in the Table. Twenty-eight of the 35 (80%) underwent cholecystectomy. Patients with concomitant gastroparesis and BD were significantly (P<0.01) more likely to have a poor outcome after cholecystectomy. Children with BD may concomitantly have GP. Concomitant GP in children with BD may negatively impact clinical outcome. Clinical Outcome in Children with Biliary Dyskinesia Categorized by Gastric Emptying Scan Result.