Abstract
Our aim is to develop a less costly but accurate test of stomach emptying and small bowel transit by utilizing selected scintigraphic observations 1–6 hr after ingestion of a radiolabeled solid meal. These selected data were compared with more detailed analyses that require multiple scans and labor-intensive technical support. A logistic discriminant analysis was used to estimate the sensitivity and specificity of selected summaries of scintigraphic transit measurements. We studied 14 patients with motility disorders (eight neuropathic and six myopathic, confirmed by standard gastrointestinal manometry) and 37 healthy subjects. The patient group had abnormal gastric emptying (GE) and small bowel transit time (SBTT). The proportion of radiolabel retained in the stomach from 2 to 4 hr (GE 2 hr, GE 3 hr, GE 4 hr), as well as the proportion filling the colon at 4 and 6 hr (CF 4 hr, CF 6 hr) were individually able to differentiate health from disease (P<0.05 for each). From the logistic discriminant model, an estimated sensitivity of 93% resulted in similar specificities for detailed and selected transit parameters for gastric emptying (range: 62–70%). Similarly, combining selected observations, such as GE 4 hr with CF 6 hr, had a specificity of 76%, which was similar to the specificity of combinations of more detailed analyses. Based on the present studies and future confirmation in a larger number of patients, including those with less severe motility disorders, the 2-, 4-, and 6-hr scans with quantitation of proportions of counts in stomach and colon should provide a useful, relatively inexpensive strategy to identify and monitor motility disorders in clinical and epidemiologic studies.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Camilleri M, Phillips SF: Disorders of small intestinal motility. Gastroenterol Clin North Am 18(2):405–424, 1989
Lennard-Jones JE: Functional gastrointestinal disorders. N Engl J Med 308:431–435, 1983
Malagelada JR, Camilleri M: Unexplained vomiting: A diagnostic challenge. Ann Intern Med 101:211–218, 1984
Camilleri M, Colemont LJ, Phillips SF, Brown ML, Thomforde GM, Chapman NJ, Zinsmeister AR: Human gastric emptying and colonic filling of solids characterized by a new method. Am J Physiol 257:G284-G290, 1989
Greydanus MP, Camilleri M, Colemont LJ, Phillips SF, Brown ML, Thomforde GM: Ileocolonic transfer of solid chyme in small intestinal neuropathies and myopathies. Gastroenterology 99:158–164, 1990
Proano M, Camilleri M, Phillips SF, Brown ML, Thomforde GM: Transit of solids through the human colon: Regional quantification in the unprepared bowel. Am J Physiol 258:G856-G862, 1990
Malagelada J-R, Camilleri M, Stanghellini V: Manometric Diagnosis of Gastrointestinal Motility Disorders. New York, Thieme-Stratton, 1986
Stanghellini V, Camilleri M, Malagelada J-R: Chronic idiopathic intestinal pseudo-obstruction: Clinical and intestinal manometric findings. Gut 28:5–12, 1987
Elashoff JD, Reddy TJ, Meyer JH: Analysis of gastric emptying data. Gastroenterology 83:1306–1312, 1982
SAS Users Guide: Statistics. Cary, North Carolina, SAS Institute, 1982, pp. 15–37, 297–308
SUGI Supplemental Library User's Guide: Cary, North Carolina, SAS Institute, 1986, pp 269–293
Hanley JA, McNeil BJ: The meaning and use of the area under a receiver operating characteristic (ROC) curve. Radiology 143:29–36, 1982
Camilleri M, Malagelada J-R, Brown ML, Becker G, Zinsmeister AR: Relation between antral motility and gastric emptying of solids and liquids in humans. Am J Physiol 249:G580-G585, 1985
Camilleri M, Brown ML, Malagelada J-R: Relationship between impaired gastric emptying and abnormal gastrointestinal motility. Gastroenterology 91:94–99, 1986
Bond JH, Levitt MD: Investigation of small bowel transit time in man using pulmonary H2 measurements. J Lab Clin Med 85:546–559, 1974
Kellow JE, Borody TJ, Phillips SF, Haddad AC, Brown ML: Sulfapyridine appearance in plasma after salicylsulfapyridine: Another simple test of intestinal transit. Gastroenterology 91:396–420, 1986
Holt S, McDicken WN, Anderson T, Stuart IC, Heading RC: Dynamic images of the stomach by real-time ultrasound. Gut 21:597–601, 1980
Holt S, Cervantes J, Wilkinson AA, Wallace JHK: Measurement of gastric emptying rate in humans by real-time ultrasound. Gastroenterology 90:918–923, 1986
Sutton JA, Thompson S, Sobnack R: Measurement of gastric emptying rates by radioactive isotope scanning and epigastric impedance. Lancet 1:898–900, 1985
Gilbey SG, Watkins PJ: Measurement by epigastric impedance of gastric emptying in diabetic autonomic neuropathy. Diabetic Med 4:122–126, 1987
Read NW: Tests of gastric motility-summary and conclusions.In Gastrointestinal Motility: Which Test? NW Read (ed). London, Wrightson Biomedical Publishing, 1989, pp 133–140
Thompson D, Mamtora H, Gait K: Measurement of antral motor function by real-time ultrasound in health and in gastric diseases. Gastroenterology 96:A510, 1989
Mamtora H, Thompson DG: Gastric ultrasound.In Gastrointestinal Motility: Which Test? NW Read (ed). London, Wrightson Biomedical Publishing, 1989, pp 99–104
Author information
Authors and Affiliations
Additional information
This study was supported in part by Digestive Diseases Center DK34988 and Clinical Research Center RR00585 grants from National Institutes of Health, Bethesda, Maryland. A short report of this study was presented at the annual meeting of the American Gastroenterological Association, May 13–16, 1990. San Antonio. Texas, and appears in abstract form inGastroenterology 98:A333, 1990.
Rights and permissions
About this article
Cite this article
Camilleri, M., Zinsmeister, A.R., Greydanus, M.P. et al. Towards a less costly but accurate test of gastric emptying and small bowel transit. Digest Dis Sci 36, 609–615 (1991). https://doi.org/10.1007/BF01297027
Received:
Revised:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01297027