Abstract
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Objectives: The purpose of this investigation was to review our initial experience with the " Comprehensive Gastrointestinal Transit Study". This scintigraphic study analyzes motility of the entire gut, from esophagus through rectosigmoid colon. Gastric dysmotility symptoms are often associated with post-prandial upper abdominal symptoms of nausea, vomiting and pain while intestinal disorders are most commonly associated with lower abdominal pain, bloating, diarrhea and constipation, there can be overlap of upper and lower gastrointestinal dysmotility symptoms. Frequently, scintigraphic evidence supports majority of patients have multiple regions of dysmotility. Overall, the aim is to provide physicians gastric imaging that aids in more accurate diagnosis, targeted therapies and better treatment outcomes.
Methods: We reviewed the results of our first 229 patients that participated in our Comprehensive Esophago-Gastrointestinal Transit Study between August 2014 and November 2016(41 males, 188 females), age 20-79( mean 40±16). Patients ingested In-111 DTPA labeled water for the esophageal swallow, liquid only, liquid with solid combo using standardized egg substitute meal. Images and quantification were obtained for esophageal transit, liquid-only gastric emptying, liquid with solid gastric emptying, small bowel transit and colonic transit over period of 72 hours. Chart review was performed for upper/lower GI symptoms, underlying medical and surgical history on every patient.
Results: Patients were referred with either lower abdominal complaints, a combination of upper and lower abdominal complaints, and/ or poor response to their present treatment after having a prior radionuclide gastric emptying study, Of the 229 studies, 45(20%) were normal. The remaining 184 patients ( 80%) had at least one region of dymotility identified. A single regional abnormality was seen in 92 patients( 50%), 2 abnormal regions were detected in 50 patients ( 26%), 3 abnormalities in 26 patients (14%). 4 abnormalities in 15 patients(8%), and 5 abnormal motility regions in 1 patient( 2%). Delayed transit was the predominant finding in patients with dysmotility. Rapid transit was much less common, predominantly in the small bowel and colonic transit. The majority of patients with both upper and lower dymotility findings had either inflammatory/ irritable bowel disease, rheumatologic disease, or prior abdominal surgery.
Conclusions: This large study highlights the frequent occurrence of both upper and lower gastrointestinal motility disorders in the same patients. The Comprehensive Eshophago-Gastrointestinal Transit Study has proven to be an exceedingly useful tool for referring physicians to understand which motility abnormalities are present that may be causing equivocal patient symptoms, re-evaluating patients not responding to current therapy and streamlining further workup and imaging.