Addition of small‐bowel transit scintigraphy to gastric emptying for assessment of patients with upper gastrointestinal symptoms

Abstract

Background Dyspeptic symptoms are not well correlated with gastric emptying (GE) results. Aims To determine (a) prevalence of delayed SB transit (SBT) in patients undergoing GE scintigraphy for symptoms of gastroparesis; (b) symptoms associated with delayed SBT. Methods Patients with symptoms of gastroparesis underwent combined GE and SBT scintigraphy (GES/SBTS). Patients ingested a mixed solid (S)‐liquid (L) meal with egg whites labeled with 500 µCi Tc‐99 m sulfur colloid and water with 125 µCi In‐111 DTPA. Retained S and L gastric activity and percent of L In‐111 activity in terminal ileum (TI) and/or cecum/colon at 6 h were determined. Patient Assessment of Gastrointestinal Symptoms (PAGI‐SYM) assessed symptoms from 0 (none) to 5 (very severe). Key Results Of 363 patients, 174 (47.9%) had delayed S GE, 141 (38.8%) delayed L GE, and 70 (19.3%) delayed SBT. Delayed SBT was seen in 24 (6.6%) with normal S GE and 46 (12.7%) with delayed S GE. Patients with isolated delayed SBT had highest symptom scores for postprandial fullness (3.5), stomach fullness (3.4), nausea (3.2), bloating (3.2), compared to isolated delayed S GE who had highest symptom scores for postprandial fullness (3.7), nausea (3.6), stomach fullness (3.4), and early satiety (3.3). Conclusions & Inferences Delayed SBT occurred in 19.3% of dyspeptic patients using GES/SBTS. While postprandial and stomach fullness were common to both delayed S GE and delayed SBT, early satiety was associated with delayed S GE whereas bloating was associated with delayed SBT. Thus, SBTS can augment GES to help explain some symptoms associated with dyspepsia and suspected gastroparesis.

Small Bowel Transit Scintigraphy in Children With Pediatric Intestinal Pseudo-Obstruction

“…In the non-PIPO patients who had liquid SBS, the median percentage of the colonic filling (83%) was higher than the cutoff value (60%–70%), defined in the adult population (6,13). However, this figure was reduced to 72% when excluding the non-PIPO patients with lower GIMD.…”

“…According to The Society of Nuclear Medicine and Molecular Imaging and European Association of Nuclear Medicine Practice Guidelines, SBT is normal if at 6 hours, more than 40% of administered 111 In-DTPA radioactivity has reached either the terminal ileum or colon (6). This definition has been widely used as an index of normal SBT in several studies, particularly in the adult population (11)(12)(13).…”

Recent Advances in the Management of Severe Gastrointestinal Dysmotility

“… 36 Thus, a variety of segmental motility tests are often requested, the most popular of which include gastric emptying scintigraphy, x-ray colonic transit tests, and oesophageal manometry. 5 A role for combined gastric and small bowel scintigraphy has recently been suggested in patients with foregut/dyspeptic symptoms, 37 but the utility of this approach in patients with severe gastrointestinal dysmotility is unclear and would require further study in this specific population.…”

Analysis of Whole Gut Motility for the Evaluation of Diabetic Gastroenteropathy: Still the Road Untraveled?

“…In a previous study, it was observed that among patients with gastroparesis, the number of patients with both delayed small bowel transit and delayed gastric emptying was greater than the number of patients with isolated delayed small bowel transit. 6 This finding indicates that small bowel scintigraphy can be used in addition to gastric emptying tests to evaluate symptoms suspected of diabetic gastroenteropathy. 6 However, limited normative data regarding small bowel transit times are available, and the interpretation of such data can be affected by abnormal gastric or colonic motility.…”

“… 6 This finding indicates that small bowel scintigraphy can be used in addition to gastric emptying tests to evaluate symptoms suspected of diabetic gastroenteropathy. 6 However, limited normative data regarding small bowel transit times are available, and the interpretation of such data can be affected by abnormal gastric or colonic motility.…”