Clinical significance of scintigraphic rapid gastric emptying

Balan, Kottekkattu; Sonoda, Luke; Seshadri, Nagabhushan; Solanki, Chandra K.; Middleton, Stephen

doi:10.1097/mnm.0b013e32834bf262

Cited by 22 publications

(22 citation statements)

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“…3,10,28 In another study, 28% of 642 patients undergoing scintigraphy had rapid GE, perhaps because a less stringent criterion was used to define rapid GE (ie, gastric half-emptying time less than 70 minutes). 29 Nearly, one-third of patients with rapid GE1 had nausea and/or vomiting, perhaps because rapid delivery of nutrients distends and Only insulin therapy* 89 (59) 9 (33)…”

Section: Discussionmentioning

confidence: 99%

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

Kuwelker

Muthyala

O’Connor

et al. 2020

Neurogastroenterology Motil

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Aims Some patients with upper gastrointestinal symptoms have rapid gastric emptying (GE). We aimed to compare patients with normal and rapid GE and to identify phenotypes among patients with rapid GE. Methods Among 2798 patients who underwent GE scintigraphy, we compared patients with normal and rapid GE and separately, patients with rapid GE at 1 hour (GE1), 2 hours (GE2), or both (GE12). Results In 2798 patients, GE was normal (74%), delayed (18%), or rapid (8%). Among 211 patients with rapid GE, patterns were rapid GE1 (48%), 2 hours (17%), or 1 and 2 hours (35%); 42 (20%) had diseases that explain rapid GE. A combination of upper and lower gastrointestinal symptoms (54%) was more common that isolated upper (17%) or lower (28%) gastrointestinal symptoms (P < .001). Constipation was more prevalent in patients with rapid GE 2 (72%) than rapid GE 1 (47%) or rapid GE12 hours (67%) (P < .05). Among 179 diabetes mellitus (DM) patients, 15% had rapid GE, which was not associated with the DM phenotype. By multivariable analysis, insulin therapy (odds ratio [OR], 0.36; 95% confidence interval [CI], 0.15‐0.88), and weight loss (OR, 0.10; 95% CI, 0.01‐0.78) were associated with a lower risk of rapid than normal GE in DM. Conclusions Eight percent of patients undergoing scintigraphy had rapid GE, which is most frequently associated with upper and lower gastrointestinal symptoms; constipation is common. Insulin therapy and weight loss were associated with a lower risk of rapid than normal GE in DM patients.

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Section: Discussionmentioning

confidence: 99%

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

Kuwelker

Muthyala

O’Connor

et al. 2020

Neurogastroenterology Motil

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“…There is increasing recognition that rapid gastric emptying may occur not only in diabetes mellitus or after fundoplication but also in patients with functional diarrhea, functional dyspepsia, and autonomic dysfunction (9–17) We have observed that some patients with rapid early gastric emptying (e.g., at 30 or 60 minutes) have a normal gastric emptying t 50 probably because the emptying rate slows after the initial rapid phase. It is conceivable that early (i.e., at 15, 30, and 60 minutes) and late (i.e., at 240 minutes) postprandial breath samples will increase the accuracy of the GEBT for identifying rapid and delayed gastric emptying relative to scintigraphy respectively.…”

Section: Introductionmentioning

confidence: 99%

Comprehensive assessment of gastric emptying with a stable isotope breath test

Bharucha

Camilleri

Veil

et al. 2012

Neurogastroenterology Motil

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Background The [13C]-Spirulina platensis gastric emptying breath test (GEBT) with 5 samples is accurate relative to scintigraphy. This study was primarily designed to further validate this GEBT using a slightly different process for incorporating [13C] in Spirulina and to evaluate the utility of additional samples for assessing early gastric emptying. Methods After a 223 kcal test meal labeled with 99mTc and [13C]-Spirulina platensis, scintigraphic images and 5 breath samples (45, 90, 120, 180, and 240 minutes, GEBT5) were collected in 14 controls (Part A). In Part B, 9 breath samples were collected at 15, 30, 45, 60, 90, 120, 150, 180, and 240 minutes (GEBT9) in 30 subjects (15 controls, 15 dyspepsia). Using correlation between [13C] breath excretion and scintigraphic emptying, lag time (t10, time for 10% emptying), emptying at 30 min (GE30), and half time (t50) were estimated for GEBT5 (Parts A and B) and GEBT9 (Part B). Key Results t50 values for scintigraphy, GEBT5, and GEBT9 were highly concordant. t10 by GEBT9 (90% CI, 6–15 minutes) was more strongly correlated (CCC 0.80 [95% CI, 0.63–0.90]) with scintigraphy (90% CI, 5–12 minutes), than GEBT5 (10–19 minutes, CCC 0.73 [95% CI, 0.54–0.85]). The correlation between estimated values (GEBT9) and linearly interpolated values (GEBT5) was closer at 60 (CCC 0.95 [95% CI, 0.91–0.97]) than 30 minutes (CCC 0.81 [95% CI, 0.71–0.89]). Conclusions & Inferences The [13C]-Spirulina platensis GEBT can accurately measure GE. While 5 and 9 samples are equally accurate for measuring t50, GEBT9 provides a more comprehensive assessment of early GE (t10 and GE30).

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“…In a retrospective cohort of 642 patients with presumed gastroparesis and RGE, the correlation between symptoms and GET were only 62% and 29%, respectively. 18 Some studies even report a preponderance of RGE over gastroparesis in non-specific symptoms. In a small 57 patient trial exploring gastric emptying in patients with functional dyspepsia, RGE was more common (21%) than delayed gastric emptying of solids (13%).…”

Section: Discussionmentioning

confidence: 99%

“…19 Our study supports prior studies reporting the poor correlation between clinical symptomatology and the diagnosis of gastroparesis. 17,18 This study did not look at response of tGES to pain, except as part of a larger symptoms spectrum. However, a recent report did examine pain, in relation to neuropathic changes in the GI tract, and found that some patients with abdominal pain do respond well to tGES.…”

Section: Discussionmentioning

confidence: 99%

Temporary Endoscopic Stimulation in Gastroparesis-like Syndrome

Singh

McCrary

Kedar

et al. 2015

J Neurogastroenterol Motil

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Background/AimsGastroparesis-like syndrome (GLS) is defined as gastroparesis-like symptoms with normal gastric scintigraphy. While the efficacy of gastric electrical stimulation (GES) in gastroparesis is well known, the utility of GES in GLS is largely unknown. Our aim was to clarify the role of GES in GLS. We implanted consecutive patients with symptoms of gastroparesis with temporary gastric electrical stimulation and observed changes in gastric scintigraphy and total symptom score. MethodsFive hundred and fifty-one patients suffering from symptoms of gastroparesis (nausea, vomiting, bloating/distension, anorexia/early satiety, and abdominal pain) with negative endoscopy underwent gastric scintigraphy with analysis of 1) solid radionuclide gastric emptying at 1, 2, and 4 hours (% remaining); 2) area under the gastric emptying curve (AUC) at 1, 2, and 4 hours; and 3) total gastric emptying test (GET) (the sum of 1, 2, and 4 hour values). Patients were stratified into: delayed gastric emptying, normal gastric emptying, and rapid gastric emptying (Appendix). Of the 551 patients in the larger cohort, 379 had implantation of temporary gastric electrical stimulation (tGES). Gastrointestinal symptoms and gastric emptying were compared pre and post tGES implantation. ResultsAfter tGES, 2 hour gastric retention decreased (P ＜ 0.01) for the delayed patients, and increased (P ＜ 0.001) for normal and rapid patients. These changes were accompanied by improvements (P ＜ 0.001) in vomiting, nausea, and total symptom scores in all 3 subgroups.

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Clinical significance of scintigraphic rapid gastric emptying

Cited by 22 publications

References 0 publications

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

Clinical features and disturbances of gastrointestinal transit in patients with rapid gastric emptying

Comprehensive assessment of gastric emptying with a stable isotope breath test

Temporary Endoscopic Stimulation in Gastroparesis-like Syndrome

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