Gastroparesis in children

Historically, gastroparesis is characterized by delayed gastric emptying of fluids and/or solids without evidence of a mechanical gastric outlet obstruction. To provide a thorough, evidence-based overview of the diagnosis, treatment, outcome and future advances for gastroparesis in children, a web search (PubMed, Cochrane Database of Systematic Reviews, EMBASE, Clinical Evidence) was performed. Original articles and reviews were identified, examined and included as appropriate. The prevalence of gastroparesis is vague in adults and unknown in children. It is suspected on the presence of symptoms indicating gastric dysmotility (nausea, vomiting, early satiety, postprandial fullness, failure to thrive, weight loss) and is confirmed on the demonstration of delayed gastric emptying. It can be assessed with various methods from which gastric emptying scintigraphy of a radiolabeled solid meal is considered as the golden standard. Therapeutic approaches include: dietary modifications, medical treatment (prokinetics, antiemetics, intrapyloric injection of botulinum toxin, enteral feeds via jejunostomy, total parenteral nutrition) and surgical interventions (laparoscopic placement of gastric pacemaker) aiming at alleviating symptoms and maintaining optimal nutritional status. Gastroparesis in children can be challenging to diagnose and treat. Specific protocols for the evaluation of gastric emptying and for a stepwise management are required to optimise future outcomes.