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. 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. The percent of gastric emptying at 60 min in the supine position was 35% +/- 19%. After 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. 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.