Concomitant Gastroparesis Negatively Affects Children With Functional Gallbladder Disease

Chumpitazi, Bruno P.; Malowitz, Stanton M.; Moore, Warren H.; Gopalakrishna, G. S.; Shulman, Robert J.

doi:10.1097/mpg.0b013e3182455cf9

Cited by 8 publications

(6 citation statements)

References 16 publications

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“…Two studies were unable to find statistically significant correlation between functional dyspepsia and delayed gastric emptying . Biliary dyskinesia with concomitant delayed gastric emptying has been associated with poorer outcomes than biliary dyskinesia alone …”

Section: Resultsmentioning

confidence: 99%

Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

Kovacic

Elfar

Rosen

et al. 2019

Neurogastroenterology Motil

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Background Due to scarcity of scientific literature on pediatric gastroparesis, there is a need to summarize current evidence and identify areas requiring further research. The aim of this study was to provide an evidence‐based review of the available literature on the prevalence, pathogenesis, clinical presentation, diagnosis, treatment, and outcomes of pediatric gastroparesis. Methods A search of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta‐analyses guidelines with the following databases: PubMed, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Web of Science. Two independent reviewers screened abstracts for eligibility. Key Results Our search yielded 1085 original publications, 135 of which met inclusion criteria. Most articles were of retrospective study design. Only 12 randomized controlled trials were identified, all of which were in infants. The prevalence of pediatric gastroparesis is unknown. Gastroparesis may be suspected based on clinical symptoms although these are often non‐specific. The 4‐hour nuclear scintigraphy scan remains gold standard for diagnosis despite lack of pediatric normative comparison data. Therapeutic approaches include dietary modifications, prokinetic drugs, and postpyloric enteral tube feeds. For refractory cases, intrapyloric botulinum toxin and surgical interventions such as gastric electrical stimulation may be warranted. Most interventions still lack rigorous supportive data. Conclusions Diagnosis and treatment of pediatric gastroparesis are challenging due to paucity of published evidence. Larger and more rigorous clinical trials are necessary to improve outcomes.

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Section: Resultsmentioning

confidence: 99%

Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

Kovacic

Elfar

Rosen

et al. 2019

Neurogastroenterology Motil

View full text Add to dashboard Cite

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“…Thus, we can only assess whether patients included in our study met disease-defining criteria described for adults [16]. The key points include intermittent episodes of pain with a character, location, and radiation suggesting a possible biliary etiology, some degree of chronicity, and the low GB-EF.…”

Section: Discussionmentioning

confidence: 99%

Biliary Dyskinesia and Symptomatic Gallstone Disease in Children: Two Sides of the Same Coin?

2014

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Background Despite lack of consensus criteria, biliary dyskinesia (BD) is an increasingly accepted pediatric diagnosis. Aims We compared patient characteristics, outcomes, and resource utilization (before and after surgery) between children with BD and symptomatic cholecystolithiasis (LITH). Methods Data from the electronic medical record were abstracted for children diagnosed with BD or LITH between December 1, 2002, and November 30, 2012, at Children’s Hospital of Pittsburgh. Results Four hundred and ten patients were identified (BD: 213 patients, LITH: 197 patients). Patients with BD had significantly lower BMI, longer symptom duration, more dyspeptic symptoms, and were more likely to present with other symptoms. Forty-one patients (13.8 %) with BD underwent cholecystectomy despite a normal gallbladder ejection fraction (GB-EF). In 32 of these, sincalide triggered pain compared to 75 of the 155 patients with low GB-EF. After surgery, patients with BD more commonly visited gastroenterology clinics and had more GI-related hospitalizations, while emergency room visits decreased in both groups. Only the nature of biliary disease independently predicted continuing pain after surgery, which in turn was the best predictor for higher resource utilization after cholecystectomy. Conclusions A large percentage of children with BD did not meet the adult diagnostic standards. Compared to those with LITH, children with BD have more widespread symptoms and continue to use more clinical resources after surgery. These findings suggest that despite its benign prognosis, BD is increasingly treated like other potentially acute gallbladder diseases, although it has the typical phenotype of FGIDs and should be treated using approaches used in such disorders.

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“…This study points that gastroparesis may also be a cause of their symptoms, a finding also suggested by Deeb et al (5). Concomitant gastroparesis and biliary tract disease negatively affect patients with biliary tract disease (33). Psychological factors have been prominent in some patients with persistent GI symptoms after cholecystectomy (34).…”

Section: Discussionmentioning

confidence: 99%

Cholecystectomy and Clinical Presentations of Gastroparesis

et al. 2013

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Background Many patients with gastroparesis have had their gallbladder removed. Aim To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed. Methods Gastroparetic patients were prospectively enrolled into the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including Patient Assessment of GI Symptoms (PAGI-SYM). Results Of 391 subjects with diabetic (DG) or idiopathic gastroparesis (IG), 142 (36%) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46%) of T2DM compared to 19/78 (24%) T1DM and 96/254 IG (38%) (P=0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR=2.06; p=0.01), more comorbidities (OR=1.26; P<0.001), less severe gastric retention (OR(severe)=0.68; overall P=0.03) and more severe symptoms of retching (OR=1.19; P=0.02) and upper abdominal pain (OR=1.21; P=0.02), less severe constipation symptoms (OR=0.84; P=0.02), and not classified as having IBS (OR=0.51; P=0.02). Etiology was not independently associated with a prior cholecystectomy. Conclusions Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis.

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Concomitant Gastroparesis Negatively Affects Children With Functional Gallbladder Disease

Cited by 8 publications

References 16 publications

Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

Update on pediatric gastroparesis: A review of the published literature and recommendations for future research

Biliary Dyskinesia and Symptomatic Gallstone Disease in Children: Two Sides of the Same Coin?

Cholecystectomy and Clinical Presentations of Gastroparesis

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