13 C-Spirulina Gastric Emptying Breath Test Normative Values in Healthy Children: A Multicenter Study With Comparison to Symptomatic Children.

INTRODUCTION: Diagnosing pediatric gastroparesis presents a significant challenge due to lack of normative data in children. We aimed to determine normative values for gastric emptying using the nonradioactive 13 C-Spirulina gastric emptying breath test ( 13 C-GEBT) in a large cohort of healthy children (HC) and examine differences compared to children with gastroparesis-like symptoms (GLS). METHODS: A total of 301 HC ages 7-18 years completed the 13 C-GEBT with 10 different breath samples × 4 hours. 13 CO 2 excretion rate (kPCD) was determined by change in 13 CO 2 / 12 CO 2 . Outcome variables included: kPCD at 10 time points, peak (maximum) kPCD, time to peak (T max ) kPCD, and area under curve (AUC) of 13 CO 2 excretion, along with breath test half emptying time (BT t ½ ). Results were compared with 13 C-GEBT data from peripubertal and postpubertal patients 11-18 years of age with GLS. RESULTS: A total of 216 HC, 51.4% female, completed the test meal within the allotted time. Females vs. males had lower peak kPCD ( P = 0.003), longer T max ( P = 0.04), lower AUC ( P < 0.001), and longer BT_t ½ ( P < 0.0001). Peak kPCD ( P = 0.01, P < 0.001) and AUC ( P = 0.012, P < 0.001) were higher in prepubertal vs peri pubertal and postpubertal children. BT_t ½ and T max were shorter in HC vs. GLS ( P < 0.001, P < 0.0001, respectively), consistent with faster gastric emptying in HC. Normative reference values based on 5th percentile kPCD and T max were established for peripubertal and postpubertal females. An algorithm incorporating key variables demonstrated 80.8% sensitivity for diagnosis of gastroparesis. DISCUSSION: This study demonstrates sex and pubertal differences in gastric emptying in children and provides the first reference values for female children.

Duke Scholars

Author Bruno Chumpitazi Pediatrics, Gastroenterology, Hepatology and Nutrition