Can pH Monitoring Predict Gastric Emptying Measured by 13C-Acetate Breath Test in Gastroesophageal Reflux with Neurological Impairment?


Introduction: Delayed gastric emptying (DGE) often occurs in patients with gastroesophageal reflux (GER) due to neurological impairment (NI). 13C has been used as an alternative tool for measuring the gastric emptying rates. The aim of this study was to predict gastric emptying in children with GER using 13C-acetate breath test (ABT) by 24-hour pH monitoring. Methods: Nineteen patients were divided into 2 groups: a DGE group with NI (14 patients), and normal-emptying group without NI (5 patients). The liquid test meal consisted of RacolTM (5 ml/kg) mixed with 13C-acetate (50 mg for infants, 100 mg for children, and 150 mg for adolescents). 13CO2 was measured using a gas chromatograph-isotope ratio mass spectrometer. The results are expressed as the % of 13C expired per hour and cumulative 13C excretion over a 3-hour periods including the parameters of half excretion and lag time. Results: The mean half excretion time was 1.762 hour in the DGE group and 1.095 hour in the normal-emptying group (P = 0.0196). The mean lag time was 0.971 hour in the DGE group and 0.666 hour in the normal-emptying group (P = 0.0196). Therefore, DGE was significantly more prevalent in the DGE compared to the normal-emptying group. The percentage of the time when the pH was less than 4 on 24-hour esophageal pH monitoring was 21.6% ± 9.2% in the DGE group and 28.5% ± 11.6% in the normal-emptying group (P = 0.4634). Conclusion: The percentage of time when the pH is less than 4 on 24-hour pH monitoring cannot predict DGE measured by the 13C-ABT in GER.

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T. Okada, S. Honda, H. Miyagi, M. Minato and A. Taketomi, "Can pH Monitoring Predict Gastric Emptying Measured by 13C-Acetate Breath Test in Gastroesophageal Reflux with Neurological Impairment?," Surgical Science, Vol. 5 No. 1, 2014, pp. 20-24. doi: 10.4236/ss.2014.51005.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] C. Gatti, F. D. Abrola, L. Dall’Ogalio, M. Villa, F. Franchini and S. Amarri, “Is the 13C-Accetate Breath Test a Valid Procedure to Analyse Gastric Emptying in Children?” Journal of Pediatric Surgery, Vol. 35, No. 1, 2000, pp. 62-65.
[2] P. R. Rosen and S. Treves, “The Relationship of Gastroesophageal Reflux and Gastric Emptying in Infants and Children: Concise Communication,” Journal of Nuclear Medicine, Vol. 25, No. 5, 1984, pp. 571-574.
[3] J. G. Papaila, D. Wilmot, J. L. Grosfeld, F. J. Rescorla, K. W. West and D. W. Vane, “Increased Incidence of Delayed Gastric Emptying in Children with Gastroesophageal Reflux,” Archives of Surgery, Vol. 124, No. 8, 1989, pp. 933-936. 80065010
[4] D. J. Bjorkman, J. G. Moore, P. D. Klein and D. Y. Graham, “13C-Bicarbonate Breath Test as a Measure of Gastric Emptying,” American Journal of Gastroenterology, Vol. 86, No. 7, 1991, pp. 821-823.
[5] B. Braden, S. Adams, L. Duan, K. H. Orth, F. D. Maul, B. Lembcke, G. Hor and W. F. Caspary, “The [13C] Acetate Breath Test Accurately Reflects Gastric Emptying of Liquids in Both Liquid and Semisolid Test Meals,” Gastroenterology, Vol. 108, No. 4, 1995, pp. 1048-1055. 0016-5085(95)90202-3
[6] M. Choi, M. Camilleri, D. Burton, A. R. Zinsmeister, L. A. Forstrom and K. S. Nair, “13C Octanoic Acid Breath Test for Gastric Emptying of Solids: Accuracy, Reproducibility, and Comparison with Scintigraphy,” Gastroenterology, Vol. 112, No. 4, 1997, pp. 1155-1162. S0016-5085(97)70126-4
[7] G. Veereman-Wauters, Y. F. Ghoos, S. Schoor, B. Maes, N. Hebbalkar, H. Devlieger, et al., “The 13C-Octanoic Acid Breath Test: A Non Invasive Technique to Assess Gastric Emptying in Preterm Infants,” Journal of Pediatric Gastroenterology and Nutrition, Vol. 26, No. 2, 1996, pp. 111-117.
[8] G. Veereman-Wauters, “Measuring Gastric Emptying with the 13C Octanoic Acid Breath Test in Infants and Children,” Gut, Vol. 43, Supplement 3, 1998, pp. S29-S30.
[9] T. Okada, F. Sasaki, M. Asaka, M. Kato, M. Nakawawa and S. Todo, “Delay of Gastric Emptying Measured by 13C-Acetate Breath Test in Neurologically Impaired Children with Gastroesophageal Reflux,” European Journal of Pediatric Surgery, Vol. 15, No. 2, 2005, pp. 77-81.
[10] T. I. Omari and G. Davidson, “Multipoint Measurement of Intragastric pH in Healthy Preterm Infants,” Archives of Disease in Childhood. Fetal and Neonatal Edition, Vol. 88, No. 6, 2003, pp. F517-F520.
[11] A. González, C. Mugueta, D. Parra, I. Labayen, A. Martinez, N. Varo, I. Monkeal, et al., “Characterisation with Stable Isotopes of the Presence of a Lag Phase in the Gastric Emptying of Liquids,” European Journal of Nutrition, Vol. 39, No. 5, 2000, pp. 224-228.
[12] J. Boix-Ochoa and M. I. Rowe, “Gastroesophageal Reflux,” In: J. A. O’Neill, M. I. Rowe, J. L. Grosfeld, E. W. Fonkalsrud and A. G. Coran, Eds., Pediatric Surgery, Mosby-Year Book, Missouri, 1998, pp. 1007-1028.
[13] J. Bergmeijer, T. Tibboel and F. Hazebroek, “Nissen Fundoplication of Gastroesophageal Reflux Occurring after Repair of Esophageal Atresia,” Journal of Pediatric Surgery, Vol. 35, No. 4, 2000, pp. 573-576.
[14] K. Spiroglou, I. Xinias, N. Karatzas, G. Arsos and C. Panteliadis, “Gastric Emptying in Children with Cerebral Palsy and Gastroesophageal Reflux,” Pediatric Neurology, Vol. 31, No. 3, 2004, pp. 177-182.
[15] J. Estevao-Costa, M. Campos, J. A. Dias, E. Trindade, A. Teixerira-Pinto and J. L. Carvalho, “Delayed Gastric Emptying and Gastroesophageal Reflux: A Pathological Relationship,” Journal of Pediatric and Gastroenterology and Nutrition, Vol. 32, No. 4, 2001, pp. 471-474. 00005176-200104000-00015
[16] D. O. Castell, J. A. Murray, R. Tutuian, R. C. Orlando and R. Arnold, “Review Article: The Pathophysiology of Gastro-Oesophageal Reflux Disease—Oesophageal Manifestations,” Alimentary Pharmacology & Therapeutics, Vol. 20, Supplement 9, 2004, pp. 14-25. j.1365-2036.2004.02238.x
[17] M. Montgomery, R. Escobar-Billing, P. M. Hellstrom, K. A. Karlsson and B. Frenckner, “Impaired Gastric Emptying in Children with Repaired Esophageal Atresia: A Controlled Study,” Journal of Pediatric Surgery, Vol. 33, No. 3, 1988, pp. 476-480.
[18] R. R. Dozois, K. A. Kelly and C. F. Code, “Effects of Distal Antrectomy on Gastric Emptying of Liquids and Solids,” Gastroenterology, Vol. 61, No. 5, 1971, pp. 675-681.

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