Experience with Esophago-Gastro-Intestinal Transit Scintigraphy – Initial 229 patients: Multiple Regions of Dysmotility are Common

Abstract

Objective: The purpose of this investigation was to review our experience with our “Comprehensive Gastrointestinal Transit Study” in the first 229 patients. This scintigraphic study analyzes motility of the entire gut, from esophagus through the rectosigmoid colon. Methods: Data were reviewed for our first two years of experience (184 females, 45 males), age 20-79 (mean 44±16) with this exam. Patients were referred with symptoms suggestive of a motility disorder. Patients first swallowed In-111 DTPA in water for the esophageal swallow study, then 300 cc for a 30 minute In-111 water only study, followed by 120 cc of In-111 water simultaneous with the solid standardized Tc-99m egg substitute meal. Images and quantification were obtained for esophageal transit, water-only gastric emptying, water with solid gastric emptying, small bowel, and colonic transit. Results: Of the 229 patient studies, 45 (20%) were normal. The remaining 184 (80%) had at least one region of dysmotility, for a total of 336 regions of abnormal motility. A single region of dysmotility was seen in 92 patients (50%), two regions in 50 (27%), three regions in 26 (14%), four regions in 12 (7%), and five regions in 4 (2%) of dysmotility. There was a poor correlation between the results of water only study and water with the solid meal. Three different patterns of delayed colonic transit were seen. Patient symptoms were often not predictive of the scintigraphic findings. Conclusion: This study highlights the frequent occurrence of dysmotility in more than one region of the gastrointestinal tract in patients with a suspected motility disorder and the frequent concurrence of both upper and lower tract dysmotility in the same patients. It provides information to referring physicians regarding which motility disorders may be causing the patient symptoms, why the patient is or is not responding to their present therapy, and if and what additional workup and therapy may be needed.