Neurogastroenterology and Motility Unit, Gastroenterology Department, Great Ormond Street Hospital for Children, London, United Kingdom.
Division of Gastroenterology and Hepatology, Department of Pediatrics, Faculty of Medicine, Prince of Songkla University, Songkhla, Thailand.
Am J Gastroenterol. 2023 Dec 1;118(12):2267-2275. doi: 10.14309/ajg.0000000000002373. Epub 2023 Jun 26.
Objective evidence of small intestinal dysmotility is a key criterion for the diagnosis of pediatric intestinal pseudo-obstruction (PIPO). Small bowel scintigraphy (SBS) allows for objective measurement of small bowel transit (SBT), but limited data are available in children. We aimed to evaluate the utility of SBS in children suspected of gastrointestinal dysmotility.
Patients undergoing gastric emptying studies for suspected foregut dysmotility, including PIPO, from 2016 to 2022 at 2 tertiary children's hospitals were recruited to an extended protocol of gastric emptying studies to allow for assessment of SBT. PIPO was classified based on antroduodenal manometry (ADM). SBT was compared between PIPO and non-PIPO patients. Scintigraphic parameters were assessed and correlated against ADM scores.
Fifty-nine patients (16 PIPO and 43 non-PIPO diagnoses) were included. SBS was performed with liquid and solid meals in 40 and 26 patients, respectively. As compared to the non-PIPO group, PIPO patients had a significantly lower median percentage of colonic filling at 6 hours, with both liquid (48% vs 83%) and solid tests (5% vs 65%). SBT in PIPO patients with myopathic involvement was significantly slower than in patients with neuropathic PIPO, both for liquid and solid meal. A significant correlation was found between solid SBT and ADM scores (r = -0.638, P = 0.036).
SBS provides a practically feasible assessment of small intestinal motility. It shows a potential utility to help diagnose and characterize PIPO. SBS seems most discriminative in PIPO patients with myopathic involvement. Studies in a larger pediatric population and across different ages are required.
小肠动力障碍的客观证据是小儿假性肠梗阻（PIPO）诊断的关键标准。小肠闪烁扫描（SBS）允许对小肠通过时间（SBT）进行客观测量，但儿童中的数据有限。我们旨在评估 SBS 在疑似胃肠道动力障碍的儿童中的应用价值。
我们招募了 2016 年至 2022 年在 2 家三级儿童医院因疑似前肠动力障碍（包括 PIPO）而行胃排空研究的患者，纳入胃排空研究的扩展方案，以允许评估 SBT。根据抗蠕动十二指肠测压（ADM）对 PIPO 进行分类。比较 PIPO 和非 PIPO 患者的 SBT。评估闪烁扫描参数并与 ADM 评分相关。
共纳入 59 例患者（16 例 PIPO 和 43 例非 PIPO 诊断）。分别对 40 例和 26 例患者进行液体和固体餐 SBS。与非 PIPO 组相比，PIPO 患者在 6 小时时结肠充盈的中位数百分比明显较低，液体（48%对 83%）和固体测试（5%对 65%）均如此。液体和固体餐时，肌病性 PIPO 患者的 SBT 明显慢于神经源性 PIPO 患者。固体 SBT 与 ADM 评分之间存在显著相关性（r = -0.638，P = 0.036）。
SBS 提供了一种可行的小肠运动评估方法。它显示出有助于诊断和特征化 PIPO 的潜在应用价值。SBS 在肌病性 PIPO 患者中似乎最具鉴别力。需要在更大的儿科人群中和不同年龄组中进行研究。
