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

Abstract

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...

Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies

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