Wireless motility capsule test in children with upper gastrointestinal symptoms.

OBJECTIVE: To compare scintigraphic gastric emptying and antroduodenal manometry (ADM) studies with the wireless motility capsule test in symptomatic pediatric patients. STUDY DESIGN: Patients aged 8-17 years with severe upper gastrointestinal symptoms (ie, nausea, vomiting, retching, abdominal pain) referred for ADM were recruited. A standardized protocol for ADM was used. On a different day, participants were given a standardized meal and then swallowed the wireless motility capsule. A wireless receiver unit worn during the study recorded transmitted data. If not performed previously, a 2-hour scintigraphic gastric emptying study was completed at the time of ADM testing. RESULTS: A total of 22 patients were recruited, of whom 21 had complete scintigraphic gastric emptying study data and 20 had complete ADM data. The wireless motility capsule test had 100% sensitivity and 50% specificity in detecting gastroparesis compared with the 2-hour scintigraphic gastric emptying study. The wireless motility capsule test detected motor abnormalities in 17 patients, compared with 10 detected by ADM. Dichotomous comparison yielded a diagnostic difference between ADM and the wireless motility capsule test (P<.01). Migrating motor complexes were recognized in all patients by both ADM and the wireless motility capsule test. The wireless motility capsule test was well tolerated in all patients, and there were no side effects. CONCLUSION: In symptomatic pediatric patients, the wireless motility capsule test is highly sensitive compared with scintigraphic gastric emptying studies in detecting gastroparesis, and seems to be more sensitive than ADM in detecting motor abnormalities.

Severe pediatric rumination syndrome: successful interdisciplinary inpatient management.

BACKGROUND: Rumination syndrome is a condition that occurs when people constantly regurgitate and expel or reswallow food soon after they eat. The most severe cases of rumination syndrome can be debilitating, requiring total parenteral nutrition or enteral tube feedings. We report our experience with the treatment of children with severe rumination syndrome. PATIENTS AND METHODS: Five patients with severe rumination syndrome received a novel inpatient interdisciplinary approach, which involved pediatric psychology, pediatric gastroenterology, clinical nutrition, child life, therapeutic recreation, and massage therapy. RESULTS: Inpatient hospitalization lasted between 9 and 13 days. The treatment was successful in all 5 of the patients. They left with complete caloric intake orally. CONCLUSIONS: This treatment protocol could benefit pediatric gastroenterologists, pediatricians, and child psychologists in managing both standard and severe cases of rumination syndrome.