Towards a less costly but accurate test of gastric emptying and small bowel transit

Camilleri, Michael; Zinsmeister, Alan R.; Greydanus, Martin P.; Brown, Manuel L.; Proano, Maritza

doi:10.1007/bf01297027

Cited by 187 publications

(140 citation statements)

References 17 publications

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“…In 1991, from a study of 14 patients and 37 healthy subjects, it was reported that a limited number of data points, at 0, 2, and 4 h, provided an approximate and adequate representation of gastric emptying when compared with more frequent image acquisition (14). The same investigator group subsequently published a study on 35 patients using the simplified protocol and reported that more patients with delayed gastric emptying were detected at 4 h than at 2 h (3).…”

Section: Discussionmentioning

confidence: 95%

Experience with a Simplified, Standardized 4-Hour Gastric-Emptying Protocol

Ziessman¹,

Bonta

Goetze

et al. 2007

Journal of Nuclear Medicine

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Gastric-emptying studies have no accepted standard methodology or reference values. A simplified standardized protocol with a large reference database has been proposed, with imaging obtained at only 0, 1, 2, and 4 h. The rationale for its 4-h length is data suggesting that delayed emptying is detected with higher sensitivity at 4 h than at 2 h. The purpose of the current investigation was to review our 2-y experience using this protocol, to determine the added value of 4-h imaging, and to determine whether the lag phase can predict delayed emptying. Methods: After ingesting a sandwich made with 99m Tc-sulfur colloid egg substitute, 175 patients were imaged immediately, every 10 min for 1 h, and then at 2, 3, and 4 h. Percentage retention was calculated for each interval. Sensitivities, specificities, predictive values, and receiver operating characteristic (ROC) curves were computed for the 1-, 2-, and 3-h intervals on the basis of normal 4-h values. Data were analyzed to determine the added value of the 4-h study. Thresholds were sought that optimized accuracy. ROC analysis was used to determine the predictive value of the lag phase. Results: Gastric emptying was delayed in 20% of patients at 2 h and in 26% at 4 h, a 29% increase in abnormal studies (P , 0.02). Of those normal at 2 h, 13% became abnormal at 4 h. Of those with delayed emptying at 2 h, 24% normalized at 4 h. Compared with the study at 4 h, the study at 2 h had a 59% sensitivity, 94% specificity, 76% PPV, and 87% NPV. ROC analysis showed that the areas under the ROC curve (AUC) were 0.75, 0.93, and 0.97 at 1, 2, and 3 h, respectively. The threshold for optimal accuracy for 3-h data was estimated to be greater than 30% retention. The accuracy of this threshold was 91%. The lag phase AUC for predicting delayed emptying at 4 h was 0.60. Conclusion: This first investigation of a large referral patient population using a standardized protocol found that abnormal emptying is detected with greater sensitivity at 4 h than at 2 h and that the lag phase is not predictive of delayed emptying.

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Section: Discussionmentioning

confidence: 95%

Experience with a Simplified, Standardized 4-Hour Gastric-Emptying Protocol

Ziessman¹,

Bonta

Goetze

et al. 2007

Journal of Nuclear Medicine

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“…However, many centers use a cutoff of Ͼ70% emptied in the first hour as indicative of accelerated gastric emptying. Identifying accelerated gastric emptying may therefore require use of higher calorie meal (16) or nutrient liquids as the radiolabeled substrate. It is also worth noting that some patients may have delayed gastric emptying at 1 and 2 h, but normal emptying by 4 h. Such patients may benefit from prokinetic therapy.…”

Section: Gastric Emptying Scintigraphymentioning

confidence: 99%

“…Additionally, scintigraphic imaging involves radiation exposure, requires costly gamma camera equipment, and is time intensive for patients and medical personnel. A simplified imaging protocol to obtain images at 1, 2, and 4 h with a standard meal was first proposed at Mayo Clinic (16), and a variation using a commercial and standardized meal was subsequently validated in a large multinational study in 123 subjects (129). The standardized meal and study protocol have been recommended for adoption across institutions by a consensus statement from the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine (1).…”

Section: Gastric Emptying Scintigraphymentioning

confidence: 99%

Methods for measurement of gastric motility

Szarka¹,

Camilleri²

2009

American Journal of Physiology-Gastrointestinal and Liver Physi

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104

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Szarka LA, Camilleri M. Methods for measurement of gastric motility. Am J Physiol Gastrointest Liver Physiol 296: G461-G475, 2009. First published January 15, 2009 doi:10.1152/ajpgi.90467.2008There is an array of tests available to measure gastric motility. Some tests measure end points, such as gastric emptying, that result from several different functions, whereas other tests are more specific and test only a single parameter, such as contractility. This article reviews the tests most commonly available in practice and research to evaluate in vivo the gastric functions of emptying, accommodation, contractility, and myoelectrical activity. The rationale for testing, the relative strengths and weaknesses of each test, and technical details are summarized. We also briefly indicate the applications and validations of the tests for use in experimental animal studies. contractility; emptying; accommodation; gastroparesis; dyspepsia ASSESSMENT OF THE MOTOR FUNCTIONS (motility) of the stomach is important in studies of gastric physiology and pathophysiology. Although not generally applied in gastroenterological practice, there is increasing use of tests to evaluate gastric function, particularly less invasive tests in clinical settings.There is an array of tests available to measure gastric motility. Some tests measure end points, such as gastric emptying, that result from several different functions, whereas other tests are more specific and test only a single parameter, such as contractility. This article reviews the tests most commonly available in practice and research to evaluate in vivo the gastric functions of emptying, accommodation, contractility, and myoelectrical activity. The rationale for testing, the relative strengths and weaknesses of each test, and technical details are summarized. A brief discussion is also provided for methods that have been used in animals to study motor functions of the stomach in animals. Tests to Evaluate Gastric Emptying of SolidsGastric emptying is a composite end point reflecting a variety of functions including gastric accommodation, the pressure gradient between the proximal and distal stomach, and antropyloroduodenal contractility and coordination. The trituration of solids and emptying of solid and liquid food from the stomach are arguably the most important physiological functions of the stomach. Abnormal gastric emptying, either accelerated at 1 h or delayed at 4 h, is among the factors that contribute to reporting of dyspepsia or the development of postprandial symptoms after meal challenge (35). For all tests of gastric motility and emptying, there are standard precautions (1): 1) Drugs affecting gastric motility (e.g., anticholinergics, narcotics, and prokinetics) are stopped for 48 h prior to the test, and the study is performed in the morning after an overnight fast. 2) Diabetic subjects should have a glucose level Ͻ275 mg/dl. 3) At the time the meal is ingested, Type 1 diabetic patients should receive half of their normal insulin dose. Gastric Emptying Scintigrap...

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“…It is important to define clinically the motor function of the stomach in order to understand the basis of the patients' symptoms and to develop appropriate therapeutic strategies (Camilleri et al, 1991). In 2000, Case et al emphasized that improvement of gastric emptying is on the top of the factors needed for achieving proper nutritional goals in critically ill patients.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic gastric emptying in protein energy malnutrition: effect of type of meal and nutritional recovery

et al. 2004

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Objective and Design: The earlier reports of disturbed gastric motility in protein energy malnutrition (PEM) point out to its possible contribution in the difficulties faced during nutritional rehabilitation. This study was thus designed to assess the ultrasonographic gastric emptying time (GET) using 20 ml/kg body weight of both liquid and semisolid meals, in 27 patients suffering from PEM as well as in 15 healthy matching infants to delineate any defect present, its degree in different types of PEM and the effect of nutritional rehabilitation. Patients: The patients were recruited from the in-patient department of Children's Hospital, Ain Shams University, Cairo, Egypt. They were divided into three groups: 10 marasmic infants, 10 marasmic kwashiorkor (marasmic KWO) and seven kwashiorkor (KWO) cases. Ultrasonographic GET assessment was carried out within 72 h of admission and 3077 days after nutritional rehabilitation. Results: The gastric half-emptying time T(1/2) of both liquid and semisolid meals was markedly prolonged in patients with marasmus and marasmic KWO. It was more delayed for the semisolid than the liquid meals. This delay was reversible after nutritional rehabilitation of the patients, indicating that it was secondary to the malnourished status. On the other hand, T(1/2) of both liquid and semisolid meals showed no statistically significant delay in the KWO group and nutritional rehabilitation added no further to the results. Conclusion: PEM, especially marasmus and marasmic KWO, causes a delay in GET, which is reversible on nutritional recovery. This must be considered during nutritional rehabilitation of such patients to decrease the duration of their hospitalization and thus decrease the morbidity in PEM. Sponsorship: This study was supported by a university fund from

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Towards a less costly but accurate test of gastric emptying and small bowel transit

Cited by 187 publications

References 17 publications

Experience with a Simplified, Standardized 4-Hour Gastric-Emptying Protocol

Experience with a Simplified, Standardized 4-Hour Gastric-Emptying Protocol

Methods for measurement of gastric motility

Ultrasonographic gastric emptying in protein energy malnutrition: effect of type of meal and nutritional recovery

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