Measurement of gastric emptying by standardized real-time ultrasonography in healthy subjects and diabetic patients.

Abstract

The aim of this study was to simplify and standardize a reproducible, well-tolerated and clinically applicable method for the assessment of gastric emptying rate by real-time ultrasonography. A total of 33 subjects were examined, including 19 healthy subjects and 14 patients with insulin-dependent diabetes mellitus and clinically suspected delayed gastric emptying. Measurements of the gastric antrum were taken in the supine position and in relation to internal landmarks to obtain a standardized cross-sectional image producing the area of a selected slice of the antrum. Diabetic patients were examined on the condition that the fasting blood glucose level was 3.5 to 9.0 mmol/l. Gastric emptying rate was estimated and expressed as the percentage reduction in antral cross-sectional area from 15 to 90 min after the ingestion of a standardized semisolid breakfast meal (300 g rice pudding, 330 kcal). Interobserver and intraobserver measurement errors were assessed, as was the significance of age and sex on gastric emptying. In comparison to healthy subjects, diabetic patients showed significantly wider median values of the 90 min postprandial antral area, but only a mild tendency toward greater dilation of the gastric antrum prior to and 15 min after meal ingestion. The median value of gastric emptying rate in these diabetic patients was estimated at 29%, which was less than half of that in the healthy subjects (63%). Statistically the difference was highly significant. Interpersonal variability of gastric emptying rate and antral areas was large for both groups. Measurements of gastric emptying rate gave highly reproducible results on separate days and from different observers (interobserver systematic measurement error 0.3% and random measurement error 10.9%; intraobserver systematic measurement error 3.6% and random measurement error 9.5%). No difference in gastric emptying rate was found related to age or sex. We conclude that the use of standardized real-time ultrasonography to determine gastric antral cross-sectional area in a single section of the stomach is a valid method for estimating gastric emptying rate.

Gastroparesis among Type 1 and Type 2 Diabetic Patients in the United Arab Emirates

“…The mean value of GER in the Emirati diabetic patients was estimated to be 17%, which is less than half the rate in the healthy volunteers (50%), (p < 0.001). In a study on Swedish diabetic patients, using the same standardized ultrasound method for gastric assessment [19], the median GER was higher (29%) than the one reported in this study (17%), even though the Swedish patients were selected for clinically suspected gastroparesis. This could be explained by differences in caloric content of the test meals since the rate of gastric emptying is a function of the caloric density of the ingested meal [21]- [23].…”

“…However, studies have shown that this reduction is not large enough to be relevant [32]. Some studies have shown a difference between females and males regarding gastric emptying [33] [34] while others did not find any difference [19]. Obesity seems to be related to lower GLP levels and increased gastric emptying [35]- [37].…”

“…Gastric emptying was assessed using a standardized ultrasound method [19] [20]. The patients were examined with a Philips iU22 ultrasound equipment (Royal Philips Electronics, The Netherlands).…”

Association between polymorphism of dopamine D2 receptor genes and therapeutic effect of domperidone in functional dyspepsia

“…Ultrasonography examination indirectly determines gastric emptying by real-time evaluation of changes in the antral area. Further studies showed that the values obtained with real-time ultrasonography did not differ grossly from those obtained with scintigraphy (15,16). In this study, our results showed that real-time ultrasonography significantly correlated with the clinical symptom scores of FD, and could be used as an objective method for the evaluation of FD.…”

Ultrasonography of the Stomach

“…Research studies have shown an overall delayed rate of gastric emptying in functional dyspepsia, with occasional, more rapid initial emptying (Lunding et al, 2006) and an overall delayed rate of gastric emptying in patients with longstanding type 1 (Darwiche et al, 1999) and type 2 (Bian et al, 2011) diabetes. …”