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      Nissen fundoplication for gastroesophageal reflux: No deterioration of gastric emptying measured by 13C-acetate breath test

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          Abstract

          Aim:

          To study the gastric emptying 30 days after laparoscopic Nissen fundoplication (NF) in gastroesophageal reflux.

          Materials and Methods:

          Three patients were evaluated with 13C-acetate breath test (ABT) performed pre and post-NF. The liquid test meal consisted of Racol mixed with 13C-acetate.

          Results:

          In the patient without neurological impairment (NI), the preoperative t ½ex and t lag were 0.900 and 0.510 hours, respectively. The postoperative t ½ex and t lag were 0.959 and 0.586 hours, respectively. In one patient with NI, the preoperative t ½ex and t lag were 1.828 and 1.092 hours, respectively. The postoperative t ½ex and t lag were 2.081 and 1.025 hours, respectively. In the other patient with NI, the preoperative t ½ex and t lag were 2.110 and 0.980 hours, respectively. The postoperative t ½ex and t lag were 1.118 and 0.415 hours, respectively.

          Conclusions:

          Our findings suggest that 13C-ABT parameters did not worsen in any of the children after laparoscopic NF.

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          Most cited references26

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          The [13C]acetate breath test accurately reflects gastric emptying of liquids in both liquid and semisolid test meals.

          The current standard for gastric emptying studies are radioactive isotope methods. [13C]breath tests have been developed as a nonradioactive alternative. The aim of this study was to validate a [13C]acetate breath test as a measure of gastric emptying of the liquid phase both in liquid and semisolid test meals by simultaneous radioscintigraphy. Thirty-five patients with dyspeptic symptoms and 20 healthy volunteers were tested using a semisolid oatmeal or a liquid test meal. Both test meals were labeled by 150 mg sodium [13C]acetate and (in patients) by 45 MBq 99mTc-albumin colloid. Half-time of gastric emptying was calculated after curve fitting of the 13C exhalation to a modified power exponential function. 99mTc-albumin emptying was measured by conventional radioscintigraphy. The half-emptying times for the [13C]acetate breath test closely correlated to those measured by radioscintigraphy both for semisolids (r = 0.87) and liquids (r = 0.95). The time of maximum 13CO2 exhalation was itself a reliable parameter compared with the half-emptying times obtained by scintigraphy (r = 0.85 for semisolids; r = 0.94 for liquids). The [13C]acetate breath test is a reliable and noninvasive tool for the analysis of gastric emptying rates of liquid phases without radiation exposure.
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            [13C]octanoic acid breath test for gastric emptying of solids: accuracy, reproducibility, and comparison with scintigraphy.

            Previous work suggested that a breath test using 13C accurately measures gastric emptying of solids. Thus, breath test half emptying time (t1/2) minus 66 minutes was claimed to estimate accurately t1/2 by scintigraphy. The aim of this study was to evaluate the accuracy and reproducibility of this breath test in healthy subjects. Fifteen volunteers (8 men and 7 women; mean age, 41 +/- 13 years) underwent simultaneous scintigraphy and [13C]octanoic acid breath test. Scans and breath samples were obtained every 15 minutes for 4 and 6 hours, respectively. The breath test was repeated three times within a 3-week period. Parameters from scintigraphy and breath test were not correlated significantly. Differences of lag phase and t1/2 between the two tests were highly variable (range for t1/2, -33.1 to 169.6; mean, 48.0 minutes). Increasing breath test "duration" (samples over 4, 5, or 6 hours) yielded decreasing estimates of the lag phase and t1/2. Although widely different values were observed in some subjects, repeated breath tests showed a high degree of reproducibility within individuals (mean coefficient of variation, 12%). [13C]Octanoic acid breath test for gastric emptying of solids requires further validation before it can substitute for scintigraphy as a diagnostic test, but it seems useful for intraindividual comparisons.
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              Vomiting and gastroesophageal motor activity in children with disorders of the central nervous system.

              Vomiting is common in children with disorders of the central nervous system (CNS) and is usually ascribed to gastroesophageal reflux (GER). However, recent acquisitions on the pathophysiology of vomiting suggest that the dysmotility of the foregut may be more widespread. Fifty-five children with CNS disorders, 50 of whom suffered from retching and/or vomiting (18 following fundoplication) were studied. We assessed GER by 24 hour pH monitoring and endoscopy, gastric electrical activity by electrogastrography, and gastric half-emptying time (T1/2) of a milk meal be electrical impedance tomography. Of the 50 vomiting patients, 29 had GER (reflux index of 5.7%-87.4%; controls: < 5%), and 31 had gastric dysrhythmias (12 tachyarrhythmia at 5.5-11.2 cpm, 4 bradyarrhythmia at 1.7-1.9 cpm, 15 unstable electrical activity; controls; 2.2-4.0 cpm). Sixteen patients had GER and gastric dysrhythmias. Eleven of 18 patients with fundoplication had gastric dysrhythmias. Gastric T1/2 was delayed in 12 of 13 patients with gastric dysrhythmia (6 with GER), versus 2 of 5 with GER alone. No abnormalities were detected in the 5 patients who did not suffer from vomiting. Children with CNS disorders who vomit have abnormal gastric motility as often as GER. Following fundoplication, many patients continue to have symptoms possibly related to gastric dysrhythmias, the effects of which may be unmasked by fundoplication. Foregut dysmotility may be related to abnormal modulation of the enteric nervous system by the CNS or to involvement of the enteric nervous system by the same process affecting the brain.
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                Author and article information

                Journal
                J Indian Assoc Pediatr Surg
                JIAPS
                Journal of Indian Association of Pediatric Surgeons
                Medknow Publications & Media Pvt Ltd (India )
                0971-9261
                1998-3891
                Oct-Dec 2011
                : 16
                : 4
                : 137-141
                Affiliations
                [1]Department of Pediatric Surgery, Hokkaido University Hospital, Sapporo, Japan
                Author notes
                Address for correspondence: Dr. Tadao Okada, Department of Pediatric Surgery, Hokkaido University Hospital, Kita-ku, Kita 14, Nishi 5, Sapporo 060-8648, Japan. E-mail: okadata@ 123456med.hokudai.ac.jp
                Article
                JIAPS-16-137
                10.4103/0971-9261.86866
                3221155
                22121311
                8567fb62-34f7-4201-b85e-2dc9c168fd87
                Copyright: © Journal of Indian Association of Pediatric Surgeons

                This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Categories
                Original Article

                Surgery
                13c-acetate breath test,laparoscopic nissen fundoplication,gastroesophageal reflux,gastric emptying rate,pyloroplasty

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