LAS VEGAS — The addition of flavoring to barium concentrate (VoLumen) was tied to a significantly decreased need for “onerous” nasogastric tube administration in kids with suspected inflammatory bowel disease (IBD) undergoing CT or MRI enterography, researchers reported here.
In 275 pediatric patients who received agent (Breeza), 1% required nasogastric tube (NGT) administration compared with 7% of patients given the standard barium concentrate contrast agent (P=0.0003), according to Leonard Haas, a medical student at the Mayo Clinic in Rochester, Minnesota, and colleagues.
The flavored oral contrast agent contains sorbitol and mannitol, the authors explained in a poster presentation at the Crohn’s and Colitis Congress (CCC).
“To get a good image of the bowel, you have to drink a lot of … contrast, and the standard barium contrast doesn’t taste good; it causes diarrhea; nausea and lots of issues,” Haas told MedPage Today. “We did previous studies, which found that healthy adults liked the taste of the new agent better, but we wanted to see if there were more objective measures. We asked this time about how it worked in children with abdominal disease.”
For this retrospective review, pediatric patients with suspected IBD undergoing CT or MR enterography from January 2014 to June 2016 ingested either conventional low-concentration barium suspension or the flavored agent.
The researchers assessed the type of oral contrast, the need for NGT administration, amount ingested, emesis, distal extent of contrast within the small bowel, degree of small bowel distention, terminal ileum (TI) transverse dimension, and diagnostic confidence in presence or absence of TI disease. Studies were blindly reviewed by three abdominal radiologists.
A little over 500 patients (314 female) with a median age of 13.5 years had 591 CT or MR enterography scans. Of those, 316 scans were performed with standard contrast and 275 with the flavored agent.
Haas’ group reported that most children consumed the entire amount, which was about 1.5 L (97% for standard agent and 97% for flavored agent, P=0.88). One percent of the children drinking the flavored contrast experienced vomiting compared with 3% of the patients drinking the barium concentrate (P=0.13).
The authors found no significant difference in measures of small bowel distention or distal extent (P>0.07), except for the distension of the mid-ileum (flavored > standard, P=0.02).
Diagnostic confidence was nearly identical (P=0.94), they reported.
The exams with the study agent “demonstrated a slight but significant increase in distal extent of contrast luminal distension (P=0.03),” they wrote.
“We observed that with the new agent, it did go a bit further in the intestine than the low-concentration barium, and the new agent does distend the lumen further than the standard barium contrast,” Haas added.
Finally, the flavored agent “was associated with significantly decreased need for onerous NGT administration (P=0.0003),” the authors concluded.
Haas noted that “inflammatory bowel disease patients have a lot of disease in the ileum and ileocolonic region, [so] we want to make sure that it is distended properly, and that the patients drink enough to distend it properly … Adults may be able to tolerate the barium contract better, but with kids you can barely get them to eat broccoli let alone a nasty, chalky barium contrast.”
He added that the flavored agent is commercial available and that his group has about 2 years of data on its effectiveness in a pediatric population.
Brent Polk, MD, of Children’s Hospital Los Angeles and CCC chair, told MedPage Today, that, “This study really addressed an unmet need in pediatric patients with inflammatory bowel disease. We need to be able to see what is happening with them, and we need these oral fluid contrast agents to perform studies, especially MRI scans.”
“Getting kids to take these agents can be challenging, and when you have to put in a nasogastric tube, that can be upsetting to both the patient as well as the patient’s family,” he added.
Haas and Polk disclosed no relevant relationships with industry.