Pediatric Gastroparesis Registry

Study Overview
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Brief Summary
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The objective of the Pediatric Gastroparesis Registry is to create a national prospective registry of children and adolescents with gastroparesis and gastroparesis-like syndrome (symptoms of gastroparesis but normal gastric emptying).

Detailed Description
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In the Pediatric Gastroparesis Registry (PGpR), we will collect detailed epidemiological, clinical, psychological, and patient outcome data with the goal of classifying patients with gastroparesis and gastroparesis-like syndromes into pathophysiologically defined phenotypes. The Primary Objective is to create a national prospective registry of children and adolescents with gastroparesis and gastroparesis-like syndrome (symptoms of gastroparesis but normal gastric emptying) to include: Demographic, clinical, psychological, nutritional characteristics, physiological measures, and serial assessments of symptoms over 3 years while receiving clinical care; Establish a Biorepository of plasma, serum, peripheral blood mononuclear cells (PBMC), GI mucosal biopsies (in those undergoing upper GI endoscopy), urine and stool collected from the children and adolescents in this registry which will allow for future analyses such as cytokines, bacterial DNA and microbiome to investigate the etiology and pathogenesis of gastroparesis in children. Secondary Objectives: To determine what factors, if any, play a role in the outcomes of children who do not improve within two years of diagnosis To assess the spectrum of symptom severity of the cardinal gastroparesis symptoms: nausea, vomiting, early satiety, postprandial fullness (and upper abdominal pain, if present) in children with gastroparesis To assess several areas of gastric motility in pediatric patients with symptoms of gastroparesis (e.g., intragastric meal distribution, global gastric emptying) To capture the clinical symptomatic course (outcome) of pediatric patients followed in the registry To determine whether gastroparesis symptoms are correlated with gastric emptying in a pediatric population To characterize abdominal pain in patients with gastroparesis and gastroparesis-like syndrome by using questionnaires, water load satiety testing and quantitative sensory testing (QST) Determine the prevalence of hypermobility spectrum disorders in pediatric patients with gastroparesis To determine if the volume of water consumed during the water load satiety test is an indirect measure of gastric accommodation To determine if the water load satiety test is associated with an increased severity of gastroparesis symptoms (fullness, bloating, abdominal pain, etc). To compare the intragastric meal distribution during scintigraphy to symptoms of early satiety, postprandial fullness in patients with symptoms of gastroparesis Define immune cell profiles, cytokine induction and epigenetic changes in diabetic and idiopathic gastroparesis

Official Title
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Pediatric Gastroparesis Registry: Pediatric Registry of Patients With Suspected Gastroparesis

Conditions
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Gastroparesis, Gastroparesis-like Syndrome

Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Cardinal symptoms of gastroparesis of at least 12 weeks duration. Cardinal symptoms of gastroparesis are the constellation of some combination of: nausea, vomiting, early satiety, postprandial fullness; symptoms sometimes may be accompanied by upper abdominal pain An etiology of either diabetic, idiopathic, or post-fundoplication gastroparesis or gastroparesis-like disorder (symptoms of gastroparesis but normal gastric emptying; see below) Gastric emptying scintigraphy (GES) of solids using the 4-hour Egg Beaters® protocol (or equivalent generic liquid egg white meal) within the last 12 months with either: Abnormal gastric emptying rate defined as an abnormal 2-hour (>60% retention) and/or 4-hour (>10% retention) result based on a 4-hour scintigraphic gastric emptying study. (This group will comprise  75% of patients in the registry) Patients with a normal gastric emptying rate, but who have symptoms of gastroparesis. (This group will comprise  25% of patients in the registry) Age at least 5 years, and under 18 years at initial screening visit Exclusion Criteria: Inability to comply with or complete the scintigraphic gastric emptying test (including allergy to eggs) Pregnancy Autism spectrum disorder, significant developmental delay, psychosis, or a history of bipolar disorder (because of inability to complete the gastroparesis symptom questionnaires: 24-hour recall and gastroparesis cardinal symptom questionnaire (the latter to be completed during the scintigraphy if possible) Use of narcotic analgesics greater than three days per week Presence of conditions associated with GI mucosal disease (e.g., inflammatory bowel disease, known eosinophilic gastroenteritis or eosinophilic esophagitis) Presence of any other condition that could cause delayed gastric emptying including: Gastrointestinal obstruction confirmed by EGD, UGI, or abdominal CT Primary neurological conditions that can cause nausea and vomiting such as increased intracranial pressure, space occupying or inflammatory/infectious lesions Acute or chronic renal failure (abnormal creatinine for age) and/or on hemodialysis or peritoneal dialysis Acute liver failure Advanced liver disease (features of portal hypertension) Clinically significant congenital heart disease (i.e., vagal injury during cardiac repair) History of esophageal, gastric or bowel surgery excepting prior fundoplication Metabolic disease including mitochondrial disease and inborn errors of metabolism Chronic lung disease (including cystic fibrosis) A serious chronic medical condition (e.g., cystic fibrosis) Use of medications that can affect motility during the gastric emptying study Any other condition, which in the opinion of the investigator, could explain the symptoms or interfere with study requirements Inability to obtain informed consent/assent

Ages Eligible for Study
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Minimum Age: 5 Years
Maximum Age: 17 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Ages 5-9, gastroparesis<br>Participants 5-9 years of age at screening with documented gastroparesis (delayed gastric emptying) | |
| Ages 5-9, gastroparesis-like syndrome<br>Participants 5-9 years of age at screening with cardinal symptoms of gastroparesis, but who have normal gastric emptying | |
| Ages 10-17, gastroparesis<br>Participants 10-17 years of age at screening with documented gastroparesis (delayed gastric emptying) | |
| Ages 10-17, gastroparesis-like syndrome<br>Participants 10-17 years of age at screening with cardinal symptoms of gastroparesis, but who have normal gastric emptying | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in water load satiety volume consumed | The Water Load Satiety Test involves the participant drinking refrigerated spring water (4 degrees C) from a 1-liter container over a period of 5 minutes until feeling completely full. The total volume of water consumed (mL) over 5 minutes is the unit of measure, and the outcome is assessed by calculating the change in volume consumed (24 weeks - baseline). | 24 weeks | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Change in Pediatric Quality of Life (PedQL) Generic Core Scale | Pediatric Quality of Life Inventory (PedsQL) Generic Core Scale is completed by the child, and is composed of 23 items comprising 4 dimensions: Physical Functioning, Emotional Functioning, Social Functioning, and School Functioning. Each item is answered using a 3-point scale: 0 (Not at all), 2 (Sometimes), 4 (A lot). Items are reversed scored and linearly transformed to a scale from 0 to 100, with higher scores indicating lower problems. The Total Score is calculated as the sum of all the items over the number of items answered on all the scales. The outcome is assessed by calculating the change in Total Score (48 weeks - baseline). | 48 weeks | 
| Change in Pediatric Quality of Life (PedQL) Gastrointestinal Symptom Scale | Pediatric Quality of Life (PedQL) Gastrointestinal Symptoms Scale is completed by the child, and is composed of 58 items comprising 10 dimensions: Stomach Pain and Hurt, Stomach Discomfort When Eating, Food and Drink Limits, Trouble Swallowing, Heart Burn and Reflux, Nausea and Vomiting, Gas and Bloating, Constipation, Blood in Poop, and Diarrhea. Each item is answered using a 3-point scale: 0 (Not at all), 2 (Sometimes), 4 (A lot). Items are reversed scored and linearly transformed to a scale from 0 to 100, with higher scores indicating lower problems. The Symptom Total Scales Score is calculated as the sum of the items answered in the 10 dimensions. The outcome is assessed by calculating the change in Total Score (48 weeks - baseline). | 48 weeks |