Pediatric gastric emptying: Value of right lateral and upright positioning

Gastroesophageal reflux and gastric emptying are usually assessed simultaneously with a 1-hr procedure. After ingestion of radiolabeled formula sequential images are gathered when the infant is in the supine position. This position is adequate for gastroesophageal reflux assessment, but delays gastric emptying. Methods: We studied 48 children, 1 wk to 2 yr of age, who presented with vomiting or failure to thrive. They received ^99mTC-sulphur colloid in formula. After completing 1 hr supine imaging we obtained additional abdominal views after changing the position of the infant to right lateral for 30 min, and upright for another 30 min. Results: The percent of gastric emptying at 60 min in the supine position was 35% ± 19%. At 90 min, in the right lateral decubitus, the percent gastric emptying was 60% ± 25%. At 120 min, after an upright period, the gastric emptying was 73% ± 20%. In the supine position 19 of 48 patients showed significant emptying (defined as >40% emptying). This increased to 41 of 48 normal studies considering the right lateral position and to 45 of 48 normal studies considering the infant upright position. Conclusion: Many patients with delayed gastric emptying show significant emptying just by changing position. We routinely complement gastric emptying studies with delayed views in the right lateral and upright position.