Delay of gastric emptying measured by 13C-acetate breath test in neurologically impaired children with gastroesophageal reflux

Delayed gastric emptying often occurs in patients, including children, with gastroesophageal reflux (GER) due to neurological impairment (NI). The aim of this study was to evaluate gastric emptying of liquids in children with symptomatic GER using the C-13-acetate breath test (ABT), and to compare the gastric emptying rates between children without and with NI. Thirteen patients were divided into 2 groups: group I without NI (5 patients) and group 11 with NI (8 patients). The liquid test meal consisted of Racol™ (5 ml/kg) mixed with C-13-acetate (50 mg for infants, 100 mg for children, and 150 mg for adolescents). Breath samples were collected for (CO2)-C-13 measurement before the intake of the meal, every 15 minutes during the first 2 hours after the meal and every 30 minutes thereafter to assess the ingestion of C-13-acetate and Racol™. (CO2)-C-13 was measured using a gas chromatograph-isotope ratio mass spectrometer. The results were expressed as % of C-13 expired per hour and cumulative C-13 excretion over a 3-hour period. The half excretion time in C-13-ABT(t(1/2)ex) was 1.095 hour for group I and 1.817 hour for group II (p = 0.0045). The lag time (t lag), which reflected the initial delay of gastric emptying, was 0.666 h for group I and 1.002 h for group 11 (p = 0.0045). Gastric emptying studies can be easily and reliably carried out in children with NI using C-13-ABT. We showed that we were able to determine the gastric emptying rate by C-13-ABT in patients with GER due to NI.