Effect of percutaneous endoscopic gastrostomy over gastroesophageal reflux and gastric emptying in children with neuropsychological delay

• Grant number: 13/14579-0
• Support Opportunities: Regular Research Grants
• Start date: November 01, 2013
• End date: April 30, 2016
• Field of knowledge: Health Sciences - Medicine - Maternal and Child Health
• Principal Investigator: Rodrigo Strehl Machado
• Grantee: Rodrigo Strehl Machado
• Host Institution: Escola Paulista de Medicina (EPM). Universidade Federal de São Paulo (UNIFESP). Campus São Paulo. São Paulo , SP, Brazil
• Associated researchers: Silvio Kazuo Ogata

Abstract

Percutaneous endoscopic gastrostomy (PEG) is frequently indicated in children with dysphagia associated with neuropsychological delay (NPD). Those patients present increased morbidity due to gastroesophageal reflux disease and foregut dysmotility, but the effect of PEG on this associated conditions is controversial. This project aims to evaluate the effect of PEG on gastroesophageal reflux and gastric emptying in children with NPD. In order to accomplish that, we will compare the following parameters before and after PEG: reflux index, bolus contact time, number of reflux episodes, bolus transit velocity, and gastric emptying half-time. Also, the interaction between the initial gastric emptying half-time, its variation after PEG and the number of reflux episodes will be evaluated. Eligible patients will be children (1-18 year-old) with NPD and an indication of PEG at discretion of his/her assistant physician. Eligibility will be determined at the initial clinical evaluation, and demographic and clinical data will be collected with a standardized form (symptoms, feeding schedule, co-morbidities, ponderal data). Esophageal exposure to gastroesophageal reflux will be measured with 24-hour multichannel intraluminal impedance and pH monitoring, while the gastric emptying will be measured with 13C-acetate breath test. Both tests will be performed off medicines at the same time initially and 5 months after PEG. Impedance tracings will be manually reviewed by the principal investigator. Our hypothesis is that the esophageal exposure to refluxate bolus will increase by 50% after PEG, and that this effect is inversely related to the initial gastric emptying half-time. Sample size is accordingly estimated in 36 patients. (AU)