BACKGROUND: Ghrelin and obestatin are peptides of the gut-brain axis affecting appetite and gastrointestinal motility.METHODS: We conducted a cross-sectional, case-control study to determine pre- and postprandial serum levels of total ghrelin and obestatin along with gastric emptying scintigraphy in children with symptoms suggestive of delayed gastric emptying time (GET), not attributable to any identifiable cause.RESULTS: Twenty children with symptoms suggestive of delayed GET, of whom 9 had delayed GET, and 20 age-matched healthy children were enrolled. Preprandial ghrelin and obestatin were higher compared to controls (GHR mean level in patients and controls: 1162 pg/mL and 401 pg/mL respectively; P<0.05; OB mean level in patients and controls: 417 pg/mL and 325 pg/mL respectively; not statistically significant). Postprandial ghrelin was significantly decreased in the subgroup of patients with delayed GET (GHR mean level in children with normal and prolonged GET: 1237 pg/mL and 584 pg/mL respectively; P<0.05).CONCLUSION: Obestatin and ghrelin were deranged in children with symptoms indicative of delayed GET of unexplained etiology. Gastric emptying was prolonged in almost half of the patients thus gastric emptying scintigraphy should be considered in the investigation of children with such symptomatology.