S. Islam1, C. D. Jolley1, S. Islam1 1University Of Florida,Surgery,Gainesville, FL, USA
Introduction: Gastroparesis (GP) and Biliary Dyskinesia (BD) are both poorly understood problems of motility that cause significant symptoms in patients. These conditions have not been considered to occur in the same patient. The purpose of this study is to report a cohort of patients who had both conditions, and discuss management and outcomes in that group.
Methods: A retrospective review was performed on all children and adolescents who were treated for either GP or BD initially and developed the second disorder within 6 months. Clinical data was collected on all the patients and compiled and analyzed. Long-term follow up was obtained by phone interviews if necessary.
Results:
A total of 20 patients were included in this cohort. All were female, and the mean age was 15.7 years. Every patient had a HIDA scan (mean EF 24.8%, all had reproduction of pain with CCK injection) and gastric emptying scan (mean t1/2 =220 minutes) performed. In 12 patients, the diagnosis of BD was made first and a cholecystectomy was performed. Three cases were found to have concurrent GP, while in the remaining 9 cases the diagnosis of GP was made when the symptoms recurred, or persisted. Four of these eight cases underwent temporary GES, and two responded and had permanent GES, while the remaining two required chronic J tube feeds.
GP was the initial diagnosis in 8 girls, and they underwent temporary followed by permanent gastric electrical stimulation (GES) therapy via implantation of the device and leads. All these patients had good response to GES with symptom improvement. They then developed right upper abdominal pain, and a HIDA scan was obtained which confirmed BD. All of these patients underwent cholecystectomy. Long term follow up of the entire cohort (mean 26 months, median 20 months) reveals that there was complete relief from the BD symptoms in ALL cases. GP symptoms were managed medically in 8 cases, with 2 patients requiring feeding tube placement. Those who responded to GES (n=10) did much better with good resolution of symptoms.
Conclusion: BD and GP may occur in a synchronous or metachronous fashion, and occurred exclusively in Caucasian teenage girls in this cohort. Excellent long-term relief of symptoms can be obtained in a majority of these cases by treating both conditions. In teenage girls undergoing treatment for either BD or GP, a high index of suspicion should be maintained for the other condition and should be investigated if symptoms persist or recur.