Transpyloric propagation and liquid gastric emptying in children with foregut dysmotility

Abstract

Objectives and Study: Antroduodenal manometry (ADM) provides insight into the antral and small bowel neuromuscular function. Gastric emptying (GE) requires precise antropyloroduodenal coordination for effective transpyloric flow, the mechanisms of which are still unclear. In the present study, we aimed to correlate gastric antral function assessed by ADM with GE scintigraphy (GES) for liquid feeds in children with suspected gastrointestinal (GI) dysmotility. Methods: In a retrospective analysis, we reviewed children undergone both ADM and GES over a five-year period. ADM tracings were visually re-analysed to measure antral frequency, amplitude, motility index (MI) preprandially and postprandially. Transpyloric propagation (TPP) was defined as antegrade propagated antral activity preceding duodenal phase III of the migrating motor complex (MMC). TPP was defined as 'poor' if occuring in < 50% of all presented duodenal phase III. GES studies were assessed with the regions of interest drawn manually over the whole stomach, fundus and antrum, to calculate GE half-time (GE-T1/2) and the retention rate (RR) in each region at fixed 1 and 2 hours. Results: 52 children (34 boys, mean age: 7.2 years) were included. Twenty-one had paediatric intestinal pseudo-obstruction, 20 functional GI disorders and 11 gastroparesis. Children with poor TPP had longer GE-T1/2 (108.5 vs 65 min, p=0.024), higher RR of the whole stomach and fundus at 1 hour (80% vs 61% p=0.005; 61% vs 39.5%, p=0.009, respectively) and 2 hours (48% vs 13.5%, p=0.034; 33.5% vs 8%, p=0.046, respectively). Antral post-prandial MI inversely correlated with GET1/ 2(p=0.042), RR of the whole stomach at 1 hour (p=0.035) and antrum at 2 hours (p=0.041). Conclusion: Our study suggests that the presence of TPP during phase III motor activity plays a key role in the regulation of GE of liquid feeds. Moreover, antral findings on ADM might predict the presence of abnormal gastric motor function in children with foregut symptoms. Studies assessing the impact of TPP on solid GE are warranted.L6351750392021-06-08 <br />