Building an open source software allowing simultaneous evaluation of esophageal and gastric dysmotility in diabetic patients.

Objectives: Esophageal and gastric involvement is common in Diabetes. Usually, dysmotility diagnosis is made separately with esophageal transit and gastric emptying study (GES).The aims of this study were to evaluate simultaneously visual intra esophageal and gastric meal distribution and to develop software to quantify gastric emptying scintigraphy.

Methods: Thirty five patients with Diabetes were included in a retrospective study. Patients were studied in the morning after overnight fasting. Some medications that may have any effect on the rate of gastric emptying were stopped for two days before GES. The meal consisted some liquid egg white radiolabeled with, on average, 76 MBq of ^99mTc-sulfur colloid, and a high caloric breakfast (327 kcal). The liquid egg white radiolabeled was ingested by the standing patients, and at the same time, dynamic images after a swallow were recorded, with a gamma camera, at a rapid rate of 1s/frame for up to 60s to capture esophageal transit. Anterior and posterior images were acquired for 120s and were performed every 30 min until 240min. For this study, we developed a free and open source Fiji/ImageJ plugin to quantify gastric and oesophageal emptying kinetic following the latest guidelines. Total gastric emptying was analyzed as the percentage of radioactivity retained in the whole stomach over time using the geometric mean. Gastric retention of the ^99mTc-labeled solid meal up to 60% at 2h or up to 10% at 4h was considered delayed gastric emptying. Abnormal esophageal retention (up to 30 s) was considered as pathologic.

Results: Of the 35 enrolled patients (25 woman, 10 men; age range: 23-73 y; mean 53 y) with diabetes, 24 patients (68%) had type 1diabetes and 11 patients (32%) had type 2 diabetes. In 5 patients (14%) had the both delayed GES and abnormal esophageal transit. In 10 (28%) of 35 patients, GES had delayed and in 23 patients (65%), esophageal transit was abnormal.

Conclusions: In patients with Diabetes, esophageal and gastric dysmotility can be analyze during routine solid-meal GES in a single step. In our study, 5 of 35 patients (14%) had the both delayed GES and abnormal esophageal transit.

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