Karrento Katja, Chumpitazi Bruno P, Zhang Liyun, Simpson Pippa, Shulman Robert J
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina, USA.
Am J Gastroenterol. 2025 May 16. doi: 10.14309/ajg.0000000000003545.
Diagnosing pediatric gastroparesis presents a significant challenge due to lack of normative data in children. We aimed to determine normative values for gastric emptying using the nonradioactive 13 C-Spirulina gastric emptying breath test ( 13 C-GEBT) in a large cohort of healthy children (HC) and examine differences compared to children with gastroparesis-like symptoms (GLS).
A total of 301 HC ages 7-18 years completed the 13 C-GEBT with 10 different breath samples × 4 hours. 13 CO 2 excretion rate (kPCD) was determined by change in 13 CO 2 / 12 CO 2 . Outcome variables included: kPCD at 10 time points, peak (maximum) kPCD, time to peak (T max ) kPCD, and area under curve (AUC) of 13 CO 2 excretion, along with breath test half emptying time (BT t ½ ). Results were compared with 13 C-GEBT data from peripubertal and postpubertal patients 11-18 years of age with GLS.
A total of 216 HC, 51.4% female, completed the test meal within the allotted time. Females vs. males had lower peak kPCD ( P = 0.003), longer T max ( P = 0.04), lower AUC ( P < 0.001), and longer BT_t ½ ( P < 0.0001). Peak kPCD ( P = 0.01, P < 0.001) and AUC ( P = 0.012, P < 0.001) were higher in prepubertal vs peri pubertal and postpubertal children. BT_t ½ and T max were shorter in HC vs. GLS ( P < 0.001, P < 0.0001, respectively), consistent with faster gastric emptying in HC. Normative reference values based on 5th percentile kPCD and T max were established for peripubertal and postpubertal females. An algorithm incorporating key variables demonstrated 80.8% sensitivity for diagnosis of gastroparesis.
This study demonstrates sex and pubertal differences in gastric emptying in children and provides the first reference values for female children.
由于儿童缺乏正常数据，诊断小儿胃轻瘫面临重大挑战。我们旨在通过非放射性13C-螺旋藻胃排空呼气试验（13C-GEBT）确定一大群健康儿童（HC）的胃排空正常参考值，并研究与有胃轻瘫样症状（GLS）儿童的差异。
共有301名7至18岁的健康儿童完成了13C-GEBT，在4小时内采集10个不同的呼气样本。通过13CO2/12CO2的变化确定13CO2排泄率（kPCD）。结果变量包括：10个时间点的kPCD、峰值（最大）kPCD、达到峰值kPCD的时间（Tmax）、13CO2排泄的曲线下面积（AUC），以及呼气试验半排空时间（BT t½）。将结果与11至18岁有GLS的青春期前和青春期后患者的13C-GEBT数据进行比较。
共有216名健康儿童（51.4%为女性）在规定时间内完成了试餐。女性与男性相比，峰值kPCD较低（P = 0.003），Tmax较长（P = 0.04），AUC较低（P < 0.001），BT_t½较长（P < 0.0001）。青春期前儿童与青春期中和青春期后儿童相比，峰值kPCD（P = 0.01，P < 0.001）和AUC（P = 0.012，P < 0.001）较高。健康儿童的BT_t½和Tmax比有GLS的儿童短（分别为P < 0.001，P < 0.0001），这与健康儿童胃排空更快一致。基于第5百分位数的kPCD和Tmax为青春期中和青春期后的女性建立了正常参考值。一个纳入关键变量的算法对胃轻瘫诊断的敏感性为80.8%。
本研究证明了儿童胃排空存在性别和青春期差异，并为女童提供了首个参考值。
