Semisolid gastric emptying for investigation of gastric dysmotility

Objectives Patients with dysmotility of the stomach present with a variety of indeterminate symptoms and there is no standard pathway of investigation. We reviewed patients with a negative endoscopy but severe symptoms (mainly nausea, bloating and vomiting) who had a range of functional tests to assess gastric motility.

Methods Patients underwent a gastric emptying study (GES), an electrogastrogram (EGG) and liquid ultrasound meal (GUS). 134 patients over 2 years had all three tests and the results were reviewed. Many patients had difficulty eating and would not have tolerated a standard meal of toast and egg. A small semisolid meal of mashed potato labelled with Tc 99m Colloid was given and the patient was imaged supine for 1 hour. The dynamic sequence was reviewed along with a half time emptying with a normal range of 15-45 minutes.

Results There were 4 main outcomes from the gastric emptying study-normal (35 patients 26%), gastroparesis (58 patients 43%), rapid emptying or possible Dumping (22 patients 16%) and normal emptying but with an abnormal pattern showing an initial lag in emptying (19 patients 14%). Similar results were found with GUS in the majority of patients although there were some exceptions. 74% of patients with gastroparesis on GES also had an abnormal US which correlated well with the % of emptying on US where it was measured. 80% of patients with normal GES also had a normal US scan. Only 14% of patients with rapid emptying with GES also had a rapid US emptying. Of patients with the “lag” pattern of emptying by GES, 11% of them had rapid emptying by US. There was almost no concordance with EGG across all groups. 78% of patients had two or more symptoms. There was some correlation with symptoms and 50% of patients presenting with nausea had gastroparesis on GES.

Conclusions In conclusion the one hour dynamic semisolid gastric emptying study is very useful in assessing gastric dysmotility. However, a range of investigations is probably needed to fully investigate gastric motility in all its complexity.