Pattern of Gastric Emptying in Patients With Systemic Sclerosis

Abstract

Gastric emptying studies, using an indigenously prepared radiolabeled solid food marker in the form of Indian bread called Chapati, were performed on 13 patients with systemic sclerosis. Six patients had limited cutaneous disease and seven had diffuse cutaneous disease. Earlier, the procedure was standardized in 30 healthy volunteers. Seven of the 13 (54%) patients (five with diffuse and two with limited cutaneous disease) had delayed gastric emptying. Most of these patients had gastric symptoms. This pattern of gastric emptying may be clinically significant, particularly in patients with diffuse cutaneous disease.

Delayed gastric emptying determined using the 13C–octanoic acid breath test in patients with systemic sclerosis

“…Among 12 symptomatic patients with advanced SSc who underwent radioscintigraphy, 75% were found to have delayed gastric emptying (18). In other small series of SSc patients evaluated by scintigraphy, 50–67% of the patients showed delayed gastric emptying (16, 19–23).…”

“…Delayed gastric emptying is a severe condition in SSc patients. Nevertheless, previous studies of delayed gastric emptying are rare and have included only a small number of patients with symptomatic SSc, who were evaluated using either radioscintigraphy or ultrasonography (15–23). Among 12 symptomatic patients with advanced SSc who underwent radioscintigraphy, 75% were found to have delayed gastric emptying (18).…”

“…Delayed gastric emptying may result in severe gastrointestinal symptoms, including an inability to ingest sufficient calories, leading to malnutrition and, at later stages, to cachexia and electrolyte disturbances, and worsening of gastroesophageal reflux (1, 5–7, 9–14). In previous studies, the prevalence of delayed gastric emptying has been reported to be 50–67% in patients with SSc exhibiting gastrointestinal symptoms, as determined using scintigraphy (15–23). Although the gold standard test for the diagnosis of delayed gastric emptying is scintigraphy, this is both a complex and an expensive technique for routine use.…”

Slow Transit Constipation Associated With Excess Methane Production and Its Improvement Following Rifaximin Therapy: A Case Report

“…Colonic transit time using a previously validated protocol (20 markers each at 0, 12 and 24 hour; abdominal radiographs at 36 and 60 hour) showed 54 of 60 markers retained at 60 hour (abnormal > 14 markers) suggestive of slow colonic transit (Figure). 6 Radionuclide gastric emptying study using technetium 99-m sulfur colloid labeled standard solid meal showed clearance half time of 61 minutes (normal 83 ± 13 minutes) 7. Glucose hydrogen breath test using a standard protocol (Quin Tron Breathtracker™ Digital Microlyzer, QuinTron Inc, Milwaukee, WI, USA) revealed rise in breath hydrogen from 13 parts per million (ppm) in fasting state to 36 ppm after ingestion of 100 g glucose (abnormal > 12 ppm than basal) suggesting small intestinal bacterial overgrowth (Figure; sensitivity 44% and specificity 80%) 8.…”

Clinical effects of ghrelin on gastrointestinal involvement in patients with systemic sclerosis

“…In an autopsy study, GI muscle atrophy and fibrosis (both of which lead to decreased GI motility) were detected in the esophagus, small intestine, and colon in 74%, 48%, and 39% of patients, respectively [3]. In previous studies, 50-67% of patients with SSc report delayed gastric emptying, which correlates with symptoms of early satiety, bloating, and emesis [4][5][6][7][8][9][10][11][12]. At present, the cause of scleroderma is still unknown, and there are no effective treatments for SSc.…”