Delayed Gastric Emptying/Gastroparesis
Delayed gastric emptying, also called gastroparesis, is a condition that affects the ability of the stomach to empty its contents even though there is no blockage. The cause of the condition is unknown but a disruption of the nerve signals to the intestine may be the cause. The condition is a common complication of diabetes in adults.
The symptoms of delayed gastric emptying include:
- Vomiting (sometimes of food eaten hours before)
- Abdominal Pain
- Weight Loss
- Distended abdomen
Exams and Tests
In addition to a complete history from you and your child and a thorough physical examination of your child, the pediatric GI specialist may perform tests. Tests may be needed to evaluate for delayed gastric emptying, to assess the severity of the problem and to establish associated complications.
Upper Gastrointestinal Barium X-Ray (Upper GI)
This test will show the size and shape (known as the anatomy) of the upper GI tract through X-ray images. It will allow the doctor to see if any obstruction or structural problems may be the cause of symptoms. Before the test, the child will not be able to have anything to eat or drink for up to eight hours before the test is scheduled, depending on the age of the child. When the child arrives for the test in the X-ray area (known as Radiology) of the hospital, he or she will be given white liquid, called barium, to drink. This liquid will coat the GI tract and outline the esophagus, stomach and small intestine. If the child is not able, or refuses, to drink the barium, a tube may be placed through the nose into the esophagus, and the barium will be given through the tube.
Gastric Emptying Study
This test evaluates the emptying of the stomach and also may provide information on the presence of reflux from the stomach to the esophagus. It is done in the nuclear medicine area of Radiology and is an outpatient test (that is, the child does not need to be admitted to the hospital for the test). The child is fed a tasteless dye mixed with milk/formula/food. It is important for the child not to have anything to eat or drink for up to eight hours before the test to ensure that the stomach will be empty at the time the test is started.
For the liquid-meal version of this test, the child will drink the mixture and lie flat on a table. A special scanner will take pictures of the stomach every minute for approximately 60 minutes. The results will provide information about whether gastroesophageal reflux GER is present and the rate of stomach emptying.
For the solid-meal version of the test, the child will eat a meal of egg and toast mixed with the test dye. The child will have a special X-ray taken right after the meal, two hours later, and if needed, another two hours later. The results provide information on rate of stomach emptying.
Upper GI Endoscopy (EGD)
This test allows the pediatric GI specialist to examine the lining of the esophagus, stomach and duodenum (first part of small bowel) using a camera in a flexible tube called an endoscope.
The procedure is done in the operating room under general anesthesia so that the child will not feel any pain. The pediatric gastroenterologist will pass the endoscope through the child's mouth and examine the esophagus, stomach and the duodenum. After examining the upper GI tract, the doctor will collect biopsies (very small pieces of the tissue lining), which will be sent to a pathologist to examine under a microscope for inflammation and other signs of disease.
Before the procedure, your child's pediatric gastroenterologist will talk with you and your child and answer your questions. Some children may get a medication to help them relax before being taken to the operating room area. After the procedure, your child will be taken to the recovery room, allowed to fully awaken and then be brought out to you. The doctor will discuss the preliminary findings of the procedure and show pictures taken during the procedure. Your child will be allowed to go home in a couple of hours after the procedure but must be fully awake and able to drink liquids before being discharged home. The total time spent at the hospital will depend on the testing and the time for your child to wake up. It is best to expect to spend four to five hours at the hospital.
Eating small meals and soft foods may help relieve symptoms. For people with diabetes, better control of blood sugar levels may improve symptoms of delayed gastric emptying. Your child's doctor may prescribe a medicine that helps empty the stomach.
Points to Remember
- Delayed gastric emptying may be a symptom of another disease or condition.
- Delayed gastric emptying may follow a viral infection and may last for weeks.
- Your child's doctor will need to do tests to rule out an obstruction.
- Persistent nausea and vomiting may cause complications such as malnutrition, dehydration or an imbalance of electrolytes (important minerals in your blood and bodily fluids).