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Title: Relationship of gastrointestinal symptoms and psychosocial distress to gastric retention in children

item WONG, GREGORY - Baylor College Of Medicine
item SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC)
item MALARY, HODA - Baylor College Of Medicine
item CZYZEWSKI, DANITA - Baylor College Of Medicine
item SEGHERS, VICTOR - Baylor College Of Medicine
item Thompson, Deborah - Debbe
item CHUMPITAZI, BRUNO - Baylor College Of Medicine

Submitted to: Journal of Pediatrics
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 2/27/2014
Publication Date: 7/1/2014
Citation: Wong, G.K., Shulman, R.J., Malary, H.M., Czyzewski, D., Seghers, V.J., Thompson, D., Chumpitazi, B.P. 2014. Relationship of gastrointestinal symptoms and psychosocial distress to gastric retention in children. Journal of Pediatrics. 165:85-91.

Interpretive Summary: Some people have stomachs that empty very slowly. Very slow stomach emptying in adults can cause nausea, vomiting, and belly pain. Whether this is true for children is not known. Slow stomach emptying may be caused by viruses, diabetes, or unknown reasons. In adults, certain types of psychological distress also can slow stomach emptying. It is not known if this is true for children. The purpose of this study was to find out if children with slow stomach emptying have different symptoms (for example, nausea and belly pain) than do children without slow stomach emptying. We also wanted to know whether psychological distress is related to stomach emptying problems. We discovered that children without slow stomach emptying can experience the same kind and severity of symptoms as do children with slow stomach emptying. However, in children with slow stomach emptying, the slower the emptying, the more likely they are to wake up at night with symptoms. Psychological distress was not different between children with or without slow stomach emptying. Our results show us that symptoms alone will not tell us which children do or do not have problems with stomach emptying.

Technical Abstract: Our objective was to determine whether gastrointestinal (GI) symptoms (abdominal pain, non-pain GI symptoms, nausea) and/or psychosocial distress differ between children with/without gastroparesis and whether the severity of GI symptoms and/or psychosocial distress is related to the degree of gastroparesis. Children aged 7-18 years (N = 100; 63 female patients) undergoing a 4-hour gastric emptying scin-tigraphy study completed questionnaires evaluating GI symptoms, anxiety, and somatization for this prospective study. Spearman correlation, Mann-Whitney,t-test,and x2 tests were used as appropriate for statistical analysis. Children with gastroparesis (n = 25) were younger than those with normal emptying (12.6 +/- 3.5 vs 14.3 +/- 2.6 years, P = .01). Because questionnaire responses from 7- to 10-year-old children were inconsistent, only patient-reported symptoms from 11- to 18-year-olds were used. Within this older group (n = 83), children with gastroparesis (n = 17) did not differ from children with normal emptying in severity of GI symptoms or psychosocial distress. In children with gastroparesis, gastric retention at 4 hours was related inversely to vomiting (r =0.506, P = .038), nausea (r = 0.536, P = .019), difficulty finishing a meal (r = 0.582, P =.014), and Children's Somatization Inventory score (r = 0.544, P = .024) and positively correlated with frequency of waking from sleep with symptoms (r = 0.551, P = .022). The severity of GI symptoms and psychosocial distress do not differ between children with/without gastroparesis who are undergoing gastric emptying scintigraphy. In those with gastroparesis, gastric retention appears to be inversely related to dyspeptic symptoms and somatization and positively related to waking from sleep with symptoms.