Procedure Guideline for Adult Solid-Meal Gastric-Emptying Study 3.0

Donohoe, Kevin J.; Maurer, Alan H.; Ziessman, Harvey A.; Urbain, Jean-Luc; Royal, Henry D.; Martín-Comín, J.

doi:10.2967/jnmt.109.067843

Cited by 107 publications

(91 citation statements)

References 10 publications

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“…This is stated in gastrointestinal (4-6) and nuclear medicine review articles (13)(14)(15), textbooks (1,16), and Society of Nuclear Medicine Procedure Guidelines (17). This consensus seems to have been based on observations made from dual-phase, dualisotope solid-liquid gastric-emptying studies (18)(19)(20)(21)(22)(23).…”

Section: Discussionmentioning

confidence: 99%

The Added Diagnostic Value of Liquid Gastric Emptying Compared with Solid Emptying Alone

Ziessman

Chander

Clarke³

et al. 2009

J Nucl Med

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The medical literature states that solid gastric-emptying studies are more sensitive for the detection of gastroparesis than are liquid studies; thus, liquid studies are rarely required. However, we have seen patients with normal solid but delayed liquid emptying. The purpose of this investigation was to determine whether a study of clear liquid gastric empting has added value for the diagnosis of gastroparesis over a study of solid emptying alone. Methods: A total of 101 patients underwent both solid and liquid gastric-emptying studies, acquired sequentially on the same day. A 30-min (1-min frames) liquid study (300 mL of water with 7.4 MBq [0.2 mCi] of 111 In-diethylenetriaminepentaacetic acid) was followed by a standardized 4-h solid-meal study (a 99m Tcsulfur colloid-labeled egg-substitute sandwich meal). Emptying was quantified as a best-fit exponential emptying rate (T1/2) for liquids and percentage emptying at 4 h for solid empting. Thirty healthy volunteers underwent a study of clear liquid emptying to establish normal values. The results of the liquid and solid studies were compared. 111 In liquid downscatter into the subsequent 99m Tc solid meal results was analyzed. Results: The upper range of normal for clear liquid emptying (T1/2) for healthy volunteers was 22 min (mean 6 3 SDs) and 19 min (mean 6 2 SDs). Of 101 patients, delayed emptying was found in 36% of liquid and 16% of solid studies. Of all patients with normal solid emptying, 32% had delayed liquid emptying. 111 In downscatter into the 99m Tc window was not generally significant. Conclusion: For the detection of gastroparesis, a 30-min study of clear liquid gastric-emptying has considerable added diagnostic value over a study of solid emptying alone. The radionuclide gastric-emptying study has long been the standard clinical diagnostic test for the detection of gastroparesis. Both solid and liquid studies have been used over the years, either as individual or as dual-phase studies, for investigative and clinical purposes. Standard teaching has been that only a solid study is needed for clinical purposes because the liquid study is less sensitive for the detection of gastroparesis, and liquid studies should be reserved for patients who cannot tolerate solids (1-6).However, we have observed patients who have had delayed liquid but normal solid emptying (7). The primary purpose of this investigation was to determine, in a large patient population, whether liquid gastric emptying provided added diagnostic value over solid emptying alone for the diagnosis of gastroparesis.We chose to perform the studies on the same day to avoid potential problems (e.g., different fasting conditions, different medications, and possible intercurrent clinical conditions that might affect emptying) that might arise from separate-day studies. Thus, the clear liquid and solid gastricemptying studies were performed sequentially; that is, a 30-min water study was performed, followed by the 4-h simplified and standardized solid protocol recommended by recently published...

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Section: Discussionmentioning

confidence: 99%

The Added Diagnostic Value of Liquid Gastric Emptying Compared with Solid Emptying Alone

Ziessman

Chander

Clarke³

et al. 2009

J Nucl Med

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“…The consensus group recommended a solid-meal GE test "using readily available technology and normative data, which can provide clinicians with standardized results". This consensus recommendation was adopted by the Society of Nuclear Medicine and Molecular Imaging (Donohoe et al, 2009) and was included in a joint practice guideline from the American College of Radiology/Society for Pediatric Radiology and the Society of Nuclear Medicine and Molecular Imaging. In interpreting GE studies, one needs to understand the multiple factors that affect GE, particularly the separate roles of the fundus and antrum.…”

Section: Noninvasive Methodologiesmentioning

confidence: 99%

Exploring gastrointestinal variables affecting drug and formulation behavior: Methodologies, challenges and opportunities

Hens

Corsetti

Spiller

et al. 2017

International Journal of Pharmaceutics

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(2017) Exploring gastrointestinal variables affecting drug and formulation behavior: methodologies, challenges and opportunities. International Journal of Pharmaceutics, 519 (1-2). pp. 79-97. ISSN 1873-3476Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/39960/1/FinalVersion-Revised-FOR_EPRINTS_1_YEAR_EMBARGO_ELSEVIER.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the Creative Commons Attribution Non-commercial No Derivatives licence and may be reused according to the conditions of the licence. For more details see: http://creativecommons.org/licenses/by-nc-nd/2.5/ A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription. After oral intake, a drug formulation is challenged by several gastrointestinal (GI) barriers. Complex variables such as pH, GI secretions and GI transit/motility along the GI tract can affect drug release and absorption in a positive or negative way depending on the physicochemical properties of the drug compound (e.g. pH/pKa interplay for ionizable drugs) and/or the formulation characteristics (e.g. pHsensitive coating). In addition, inter-subject variability in characteristics of the GI environment may cause variable drug absorption and systemic drug availability (Riethorst et al., 2015). Determining the median and range for specific GI variables, and understanding how they influence oral drug behavior along the GI tract, will be helpful in the field of drug development. 2The present review provides an overview of different methodologies that can be applied to study physiological variables of the human GI tract and their impact on oral drug absorption in healthy and patient populations. The methodologies have been subdivided into two groups: (i) noninvasive and (ii) invasive methodologies. Although some of the methodologies are more historical than operational, they have been of paramount importance for innovations in drug and formulation development; in addition, they have created the basis for several novel methodologies, leading to an in-depth comprehension of different GI variables: gastric emptying (magnetic resonance imaging (MRI), scintigraphy, acetaminophen absorption technique, ultrasonography, breath test, intraluminal sampling and telemetry), motility (MRI, small intestinal/colonic manometry and telemetry), GI volume changes (MRI and ultrasonography), temperature (telemetry) and GI pH (intraluminal sampling and telemetry). Noninvasive methodologiesa. Scintigraphy Disturbances in the normal movement of food along the GI tract can be associated with abdominal pain, early satiety and nausea. Measurement of GI transit, es...

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“…The consensus group recommended a solid-meal GE test "using readily available technology and normative data, which can provide clinicians with standardized results." This consensus recommendation was adopted by the Society of Nuclear Medicine and Molecular Imaging (42) and was included in a joint practice guideline from the American College of Radiology/Society for Pediatric Radiology and the Society of Nuclear Medicine and Molecular Imaging (http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/ GI_Scintigraphy.pdf).…”

Section: Gastric Emptyingmentioning

confidence: 99%

Gastrointestinal Motility, Part 1: Esophageal Transit and Gastric Emptying

Maurer

2016

J. Nucl. Med. Technol.

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CE credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than March 2019. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test.Although not as well standardized as gastric emptying (GE) scintigraphy, esophageal transit scintigraphy, if performed in a comprehensive manner including both quantitative and qualitative analysis of single-and multiple-swallow studies, is clinically useful when expertise in esophageal manometry is not available or not tolerated and when esophageal manometry or barium videofluoroscopy results are equivocal or nondiagnostic. GE scintigraphy has undergone much-needed standardization. Both solid and liquid GE studies play an important role in assessing patients with upper gastrointestinal symptoms. Because measurement of simple total GE is often not sufficient to explain patient symptoms, there is a need to expand the analysis of GE scintigraphy to include the separate roles of the fundus and antrum and to include the complex interactions the stomach has with other organ systems.

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Procedure Guideline for Adult Solid-Meal Gastric-Emptying Study 3.0

Cited by 107 publications

References 10 publications

The Added Diagnostic Value of Liquid Gastric Emptying Compared with Solid Emptying Alone

The Added Diagnostic Value of Liquid Gastric Emptying Compared with Solid Emptying Alone

Exploring gastrointestinal variables affecting drug and formulation behavior: Methodologies, challenges and opportunities

Gastrointestinal Motility, Part 1: Esophageal Transit and Gastric Emptying

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