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Extending Gastric Emptying Scintigraphy from Two to Four Hours Detects More Patients with Gastroparesis

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Abstract

Gastric emptying scintigraphy (GES) is usually performed for up to 2 hr to measure the gastric emptying (GE) of solids. Symptomatic patients, however, may have borderline results at 2 hr, making it difficult to determine whether a gastric motor disorder is present. The aim of this study was to assess whether extending GES to 4 hr is useful in evaluating patients for gastroparesis and to correlate the results of GES with patient symptoms. We studied 129 patients undergoing GES at Temple University Hospital between July 1998 and March 1999. Solid-phase GE was measured at 0, 0.5, 1, 2, 3, and 4 hr after ingestion of a 99mTc sulfur colloid-labeled egg meal. Dyspeptic symptoms of upper abdominal discomfort, early satiety, postprandial abdominal bloating, nausea, vomiting, and anorexia were graded as none, mild, moderate and severe (0, 1, 2 and 3, respectively) with the sum representing a total symptom score. Of 129 patients, 86 had normal GE at 2 hr; 26 of the 86 normal scans at 2 hr were delayed at 3 hr. Six of the 60 scans normal at 2 and 3 hr were delayed at 4 hr. Of 43 patients with delayed GE at 2 hr, 39 were delayed at 3 hr and 35 were delayed at 4 hr. Overall, the percentage of patients with delayed GE increased from 33% at 2 hr only to 58% using the results of the 2-, 3-, and 4-hr scans (P < 0.05). There was a significantly greater symptom score in patients with delayed GE compared to patients with normal GE (8.4 ± 0.5 vs 7.1 ± 0.5; P < 0.05). Conclusion, prolonging GES after ingestion of a 99mTc-labeled egg meal from 2 to 4 hr increased the number of symptomatic patients found to have delayed GE. These results suggest that GES should be performed for up to 4 hrs when the 2-hr result is normal.

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REFERENCES

  1. Minami H, McCallum RW: The physiology and pathophysiology of gastric emptying in humans. Gastroenterology 86:1592–1610, 1984

    Google Scholar 

  2. Hoogerwerf, WA, Pashricha PJ, Kalloo AN, Schuster MM: Pain: The overlooked symptom in gastroparesis. Am J Gastroenterol 94:1029–1033, 1999

    Google Scholar 

  3. Horowitz M, Fraser RJ: Gastroparesis: Diagnosis and management. Scand J Gastroenterol 30(suppl 213):7–16, 1995

    Google Scholar 

  4. Scott AM, Kellow JE, Shuter B, et al: Intragastric distribution and gastric emptying of solids and liquids in functional dyspepsia. Dig Dis Sci 38:2247–2254, 1993

    Google Scholar 

  5. Cunningham K, Horowitz M, Riddell P, Maddern G, Myers J, Holloway RH, et al: Relationships among autonomic nerve dysfunction, oesophageal motility and gastric emptying in gastro-oesophageal reflux disease. Gut 32:1436–1440, 1991

    Google Scholar 

  6. Schwizer W, Hinder RA, DeMeester TR: Does delayed gastric emptying contribute to gastroesophageal reflux disease? Am J Surg 157:74–81, 1989

    Google Scholar 

  7. McCallum RW, Berkowitz DM, Lerner E: Gastric emptying in patients with gastroesophageal reflux. Gastroenterology 80:285–291, 1981

    Google Scholar 

  8. Dobrilla G, Comberlato M, Steele A, Vallaperta P: Drug treatment of functional dyspepsia-a meta-analysis of randomized controlled clinical trials. J Clin Gastroenterol 11:169–177, 1989

    Google Scholar 

  9. Veldhuyzen van Zanten SJO, Cleary C, Talley NJ, et al: Drug treatment of functional dyspepsia: A systematic analysis of trial methodology with recommendations for design of future trials. Am J Gastroenterol 91:660–672, 1996

    Google Scholar 

  10. Parkman HP, Miller MA, Fisher RS: Role of nuclear medicine in evaluating patients with suspected gastrointestinal motility disorders. Semin Nucl Med 25:289–305, 1995

    Google Scholar 

  11. Urbain J-LC, Siegel JA, Charkes ND, Maurer AH, Malmud LS, Fisher RS: The two-component stomach: Effects of meal particle size on fundal and antral emptying. Eur J Nucl Med 15:254–259, 1989

    Google Scholar 

  12. Horowitz M, Harding PE, Chaterton BE, et al: Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy. Dig Dis Sci 30:1–9, 1985

    Google Scholar 

  13. Camilleri M, Zinsmeister AR, Greydanus MP, Brown ML, Proano M: Towards a less costly but accurate test of gastric emptying and small bowel transit. Dig Dis Sci 36:609–615, 1991

    Google Scholar 

  14. Thomforde GM, Camilleri M, Phillips SF, Forstrom LA: Evaluation of an inexpensive screening scintigraphic test of gastric emptying. J Nucl Med 36:93–96, 1995

    Google Scholar 

  15. Maurer AH, Knight LC, Charkes ND, et al: Comparison of left anterior oblique and geometric mean gastric emptying. J Nucl Med 32:2176–2180, 1991

    Google Scholar 

  16. Parkman HP, Urbain JLC, Knight LC, Brown KL, Trate DM, Miller MA, Maurer AH, Fisher RS: Effect of gastric acid suppressants on human gastric motility. Gut 42:245–250, 1998

    Google Scholar 

  17. Buckley MJ, Scanlon C, McGurgan P, Omorain CA: A validated dyspepsia symptom score. Ital J Gastroenterol Hepatol 29:495–500, 1997

    Google Scholar 

  18. Parkman HP, Miller MA, Trate D, Knight LC, Urbain JL, Maurer AH, Fisher RS: Electrogastrography and gastric emptying scintigraphy are complementary for assessment of dyspepsia. J Clin Gastroenterol 24:214–219, 1997

    Google Scholar 

  19. Barnett JL, Behler EM, Appelman HD, Elta GH: Campylobacter pylori is not associated with gastroparesis. Dig Dis Sci 34:1677–1680, 1989

    Google Scholar 

  20. Stanghellini V, Tosetti C, Paternico A, Barbara G, Morselli-Labate AM, Moneti N, Marengo M, Corinadesi R: Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 110:1036–1042, 1996

    Google Scholar 

  21. Tougas GH, McCallum RW, Abell T, Quigley EMM, Hunt RH, et al: Gastric emptying of a low fat meal: Establishment of international control values. Gastroenterology 114:A755, 1998

    Google Scholar 

  22. Thumshirn M, Saslow SB, Camilleri M, Burton D, Hanson R, Williams DE: Postcibal gastric sensory and motor dysfunctions in non-ulcer dyspepsia NUD): What are the roles of helicobacter pylori (HP) infection and vagal function? Gastroenterology 114:A847, 1998

    Google Scholar 

  23. Urbain JLC, Vekemans MC, Parkman H, Van Cauteren J, Mayeur SM, Van Den Meagdenbergh V, Charkes ND, Fisher RS, Malmud LS and De Roo M: Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia. J Nucl Med 36:1579–1586, 1995

    Google Scholar 

  24. Waldron B, Cullen PT, Kumar R, Smith D, Jankowski J, Hopwood D, Kennedy N, Campbell FC: Evidence for hypomotility in non-ulcer dyspepsia: A prospective multifactorial study. Gut 32:246–251, 1991

    Google Scholar 

  25. Talley NJ, Shuter B, McCrudden G, et al: Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia. J Clin Gastroenterol 11:625–30, 1989

    Google Scholar 

  26. Houghton LA, Read NW, Heddle R, Horowitz M, Collins PJ, Chatterton B, Dent J: Relationship of the motor activity of the antrum, pylorus, and duodenum to gastric emptying of a solidliquid mixed meal. Gastroenterology 94:1285–1291, 1988

    Google Scholar 

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Guo, JP., Maurer, A.H., Fisher, R.S. et al. Extending Gastric Emptying Scintigraphy from Two to Four Hours Detects More Patients with Gastroparesis. Dig Dis Sci 46, 24–29 (2001). https://doi.org/10.1023/A:1005697422454

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