{
  "abstract": "Despite the increasing prevalence and healthcare costs, many cases of acute paediatric gastroparesis (GP) remain idiopathic. 1 In adults, GP is often associated with diabetes or post-surgical conditions, while approximately 70% of paediatric GP cases are idiopathic and 12% are post-surgical.2 Notably, around 7% of GP patients have a history of pancreatitis, and 44% of chronic pancreatitis patients experience GP.3 Research by Parkman et al. suggests that patients with both conditions experience worse symptoms, have a higher likelihood of requiring total parenteral nutrition, and report lower quality of life compared to those with GP alone.4 The overlap of common symptoms such as abdominal pain, nausea, and vomiting, makes diagnosing acute GP particularly challenging.GP is characterized by delayed gastric emptying and ranges from mild discomfort to severe complications, including dehydration and malnutrition. Diagnosis is difficult due to lack of standardized criteria. While paediatric GP data is limited, hospitalization rates have significantly risen over the past decade, impacting quality of life and increasing morbidity and mortality.5 A previously healthy child presented with a 12-hour history of severe epigastric pain, recurrent vomiting and fever. Clinical and biochemical assessments indicated acute pancreatitis showing elevated inflammatory markers (CRP 32 mg/L) and significantly raised amylase of 1786 iu/L. Initial nasogastric decompression yielded over3 litres of dark green bilious aspiratesA Computer Tomography (CT) imaging was organised to exclude other intra-abdominal pathologies, confirm the diagnosis of pancreatitis and evaluate for potential gallbladder stones. This showed a grossly distended stomach with a distended, fluid filled second part of the duodenum, a narrow third part, and a collapsed remainder of the small and large bowel (figure 1). Free fluid surrounding the pancreas suggested acute pancreatitis with acute gastroparesis. Subsequent magnetic resonance imaging showed significant inflammatory changes around the pancreatic head and a distended stomach. No calculi were observed in the common bile duct.The patient was treated conservatively, with nasogastric decompression, broad spectrum antibiotics, intravenous fluids and a proton pump inhibitor. In view of persistent large gastric aspirates, Polymeric feeds (Nutri Peptisob Energy) were started via a naso-jejunal tube and gradually reduced once oral intake was tolerated. Possible causes, including infection and autoimmune pancreatitis were excluded with negative blood and stool cultures, viral panel, IgG serology and normal genetic screening for pancreatitis (PRSS1, SPINK1, CFTR, CELA3B).Upon discharge from Hospital, patient was tolerating normal diet and had normal faecal elastase.Abstract OC40 Figure 1Grossly distended stomach (a)At her most recent follow-up, she was thriving, well and had no symptoms suggestive of gastroparesis or pancreatic insufficiency.This case highlights the need for increased awareness and discussion of such atypical presentations. While acute pancreatitis elevates the risk of developing gastroparesis and increases hospitalization rates,6 there is no current consensus on the optimal management strategy in acute settings.This emphasizes the necessity for further research into paediatric GP, particularly its connection to pancreatitis, as cases grow in both frequency and complexity.References Migdalis L, Thomaides T, Chairopoulus C, et al. Changes of gastric emptying rate & gastric levels are early indicators of autonomic neuropathy in type II diabetic patients. Clin Auton Res 2001;11:259–263.Waseem S, Islam S, Kahn G, et al. Spectrum of gastroparesis in children. J Pediatric Gastroenterology Nutr. 2012;55:166–172.Abell T, Yamada G, Parkmann HP, et al. Su1446: Clinical characteristics of patients with symptoms of gastroparesis & history of pancreatitis. Gastroenterology 2019;156(6):S-553–4.Trisha SP, Staller K, Braden Kuo. Pancreatitis & the risk of developing gastric neuromuscular dysfunction. Clin Exp Gastroentero. 2023;1–7.Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying & gastroparesis severity. J. Gastroenterol. 2011;140(1):101–15.e15Pasricham TS, Staller K, Kuo B. Pancreatitis & the risk of developing gastric neuromuscular dysfunction. Clin Exp Gastroentero. 2023;14:1–7.",
  "authors": [
    {
      "affiliations": [
        "Royal Alexandra Children Hospital"
      ],
      "name": "Sarah Ellul"
    },
    {
      "affiliations": [
        "Royal Alexandra Children Hospital"
      ],
      "name": "Sam Smith"
    },
    {
      "affiliations": [
        "Royal Alexandra Children Hospital"
      ],
      "name": "Farah M Barakat"
    },
    {
      "affiliations": [
        "Royal Alexandra Children Hospital"
      ],
      "name": "Jigna Sheth"
    }
  ],
  "title": "OC40 Acute gastroparesis in association with acute pancreatitis in an adolescent",
  "uid": "8719c1fd-1bdf-5618-ab91-c581ff2d613a"
}