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Parkman HP, Anand R, Barrett AC, Cooper R, Dadparvar S, Maurer AH. Normal Gastric Emptying Scintigraphy Values for Limited Meal Ingestion. Dig Dis Sci 2025; 70:1435-1440. [PMID: 39971826 PMCID: PMC11972169 DOI: 10.1007/s10620-025-08883-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2024] [Accepted: 01/17/2025] [Indexed: 02/21/2025]
Abstract
INTRODUCTION Patients with symptoms of gastroparesis are assessed with gastric emptying scintigraphy (GES). However, patients may not eat the entire meal due to their symptoms. The aim of this study was to quantify in normal subjects the effect of different ingested meal sizes and how these results could affect interpretation of patients' GES. METHODS Normal subjects underwent three GES tests ingesting the currently established Tc-99 m radiolabeled liquid egg white sandwich served as a full (100%), half (50%), or quarter (25%) meal. Percent gastric retention was calculated for each imaging time (0, 0.5, 1, 2, 3, 4 h). T1/2 for GE was calculated using power exponential curve fit. RESULTS 24 normal subjects completed three GES tests. Percent gastric retention at 0.5, 1, 2, 3 h postprandially were significantly less for half and quarter meal compared to the full meal. Mean + 2SD gastric retention values at 2 h for 50% meal and 25% meal were 41.6% and 59.5%. Compared to T1/2 for the full-size meal (94 ± 21 (SD) min), T1/2 for half meal (67 ± 19 min; p < 0.01) and quarter meal (69 ± 28 min; p < 0.01) were significantly shorter. Mean + 2SD T1/2 emptying values for 50% and 25% meal ingestion were 105.2 and 125.8 min. CONCLUSION Gastric emptying is affected by amount of the meal ingested. T1/2 was shorter, and percent retention at 0.5, 1, 2, 3 h postprandially were less for half- and quarter-size meals compared to the full meal. Based on our results, if a patient ingests 50% of the standard GES meal, > 41.6% retention at 2 h or T1/2 is > 105.2 min is consistent with delayed GE.
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Affiliation(s)
- Henry P Parkman
- Section of Gastroenterology, Temple University Department of Medicine, Philadelphia, PA, USA.
- Gastroenterology Section, Temple University School of Medicine, Parkinson Pavilion, 8th floor, Philadelphia, PA, 19140, USA.
| | - Reena Anand
- Section of Gastroenterology, Temple University Department of Medicine, Philadelphia, PA, USA
| | - Alexandra C Barrett
- Section of Gastroenterology, Temple University Department of Medicine, Philadelphia, PA, USA
| | - Rona Cooper
- Section of Gastroenterology, Temple University Department of Medicine, Philadelphia, PA, USA
| | - Simindokht Dadparvar
- Section of Nuclear Medicine, Temple University Department of Radiology, Philadelphia, PA, USA
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Alan H Maurer
- Section of Gastroenterology, Temple University Department of Medicine, Philadelphia, PA, USA
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Freiberg B. Can an Abnormal Gastric Emptying Study Be Normal? J Nucl Med Technol 2025:jnmt.124.269182. [PMID: 40037658 DOI: 10.2967/jnmt.124.269182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2024] [Accepted: 02/04/2025] [Indexed: 03/06/2025] Open
Abstract
The American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine and Molecular Imaging collaboratively wrote consensus statements to standardize gastric emptying scintigraphy. Despite this, centers are using nonstandard protocols. This study examined how these protocols contrast with standards. Methods: Consecutive charts were analyzed for meal, radionuclide dose, half-emptying time (T½) and its normal range, and documented retention and emptying. Impressions were compared with how emptying mapped on a graph based on standard 4-h values. Results: Thirty-four studies were identified. Ten of 14 abnormal studies were normal when plotted on the standard 4-h graph. Eight of 10 abnormal studies had normal 2- or 4-h retention. Normal T½ ranges varied significantly. Most altered the meal, and over 25% received a radionucleotide dose outside the recommended range. Conclusion: The upper bound of normal T½ falls within standard 4-h bounds, with many individuals given an erroneous impression. Though further optimization may be needed, adhering to standards is critical.
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Affiliation(s)
- Ben Freiberg
- Pediatric Gastroenterology, Cleveland Clinic Children's, Cleveland, Ohio
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Wulfeck MK, Ramis P, Hillman A, Nielsen P, Rohren EM. Beyond the Standard Meal: An Observational Analysis of Meals Used in Nuclear Medicine Gastric Emptying Studies. Clin Nucl Med 2025; 50:214-218. [PMID: 39668481 DOI: 10.1097/rlu.0000000000005635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2024]
Abstract
RATIONALE Standardized guidelines for meals used in adult gastric emptying studies (GES) have been available since 2009; however, there is still great variability in the diets that are clinically used in these studies. The purpose of this retrospective study is to perform an observational analysis of GES meals that are used within a national radiology practice to assess for compliance. It is hypothesized that despite having well-validated standardized meal protocols, there remains great variability in its use and interpretation. METHODS This retrospective observational analysis included 11,458 GESs and their associated reports. GES meals were divided into 5 categories including solid, liquid, dual liquid and solid, alternative meals, and other. Further analysis was performed on the solid and liquid meal GESs. The total amount of studies performed with each meal was collected as well as the percentages of the results of each study categorized as normal, delayed, rapid, and limited. RESULTS A total of 10,602 studies were included in the analysis, which included 9974 solid meals and 628 liquid meals. Of the solid meal type, the standard recommended meal was used most often followed by the protein variant meal. The oatmeal protocol had the least number of delayed results; however, there was otherwise a similar distribution of results for the remaining solid meal variants. The most common liquid meal utilized the nutritional drink or protein shake, and compared with the solid meal types, there were less rapid or limited results. CONCLUSIONS Variability remains in clinical practice regarding the type of meal that is used in GESs as well as in the interpretation of the study. Continued reinforcement of the standardized solid meal diet and validated cutoff values for interpretation remains crucial until there is increased validation and standardization of other diets.
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Shargo R, Luongo M, Mhaskar R, Lu PL, Wilsey M. Assessing the Clinical Value of 2-h Versus 4-h Gastric Emptying Scintigraphy in Pediatrics: A Systematic Review and Meta-Analysis. Neurogastroenterol Motil 2025; 37:e14978. [PMID: 39638920 DOI: 10.1111/nmo.14978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2024] [Revised: 11/11/2024] [Accepted: 11/23/2024] [Indexed: 12/07/2024]
Abstract
INTRODUCTION The gold-standard diagnostic test for gastroparesis is gastric emptying scintigraphy (GES). Although a 4-h GES is recommended in adult guidelines, no similar guidelines exist in the pediatric population, with many hospitals utilizing a 2-h scan to reduce radiation exposure and save time. METHODS We performed a systematic review and meta-analysis to evaluate differences in the diagnosis of gastroparesis during 2-h versus 4-h GES. Four databases were systematically searched for articles reporting results of GES at both the 2- and 4-h time points in a pediatric population. Outcomes included the proportion of patients with gastroparesis at 2- and 4-h and the number of patients with differing transit status (normal or abnormal) from 2- to 4-h. Meta-analyses were conducted utilizing a random effects model. Heterogeneity among studies was assessed utilizing the I2 statistic. KEY RESULTS A total of 344 records were identified, of which 9 articles met inclusion criteria. Of these, six articles were included in the meta-analysis. The pooled proportion of patients with alterations in gastric transit between 2 and 4 h was 0.2 (95% CI: 0.11 to 0.30). Overall, the extended 4-h scan captured an additional 10% of patients with gastroparesis. There was significant heterogeneity among the studies (I2 = 91.8%, p < 0.001), likely due to differences in GES protocol and patient samples. CONCLUSIONS AND INFERENCES The 4-h GES offers a higher diagnostic yield in pediatric patients compared to a 2-h study, despite heterogeneity in existing research. Further prospective studies are necessary to further quantify this advantage.
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Affiliation(s)
- Ryan Shargo
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Michael Luongo
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Rahul Mhaskar
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
- Department of Internal Medicine and Medical Education, University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Peter L Lu
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Michael Wilsey
- Department of Pediatric Gastroenterology, Johns Hopkins All Children's Hospital, Saint Petersburg, Florida, USA
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Sabat C, Lebtahi R, Duboc H, Dior M, Coffin B, Soliman H. Symptoms from the Gastroparesis Cardinal Symptom Index and clinical factors associated with delayed gastric emptying in patients with suspected gastroparesis. Neurogastroenterol Motil 2024; 36:e14821. [PMID: 38798079 DOI: 10.1111/nmo.14821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 04/15/2024] [Accepted: 05/09/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND The association between upper gastrointestinal symptoms and delayed gastric emptying (GE) shows conflicting results. This study aimed to assess whether the symptoms of the Gastroparesis Cardinal Symptom Index (GCSI) and/or the scores were associated with the result of GE tests and whether they could predict delayed GE. METHODS Patients referred for suspected gastroparesis (GP) were included in a prospective database. Demographical data, medical history, and symptoms of the GCSI score were collected for each patient. A GE scintigraphy was then performed with a 4-hour recording. Delayed GE was defined as a retention rate ≥ 10% at 4 h. RESULTS Among 243 patients included in this study, 110 patients (45%) had delayed GE. The mean age (49.9 vs. 41.3 years; p < 0.001) and weight loss (9.4 kg vs. 5.6 kg; p = 0.025) were significantly higher in patients with delayed GE. Patients with diabetes or a history of surgery had a higher prevalence of delayed GE (60% and 78%, respectively) than patients without comorbidity (17%; p < 0.001). The GCSI score was higher in patients with delayed GE (3.06 vs. 2.80; p = 0.045), but no threshold was clinically relevant to discriminate between patients with normal and delayed GE. Only vomiting severity was significantly higher in patients with delayed GE (2.19 vs. 1.57; p = 0.01). CONCLUSION GE testing should be considered when there are symptoms such as a higher weight loss, comorbidities (diabetes, and history of surgery associated with GP), and the presence of vomiting. Other symptoms and the GCSI score are not useful in predicting delayed GE.
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Affiliation(s)
- Claire Sabat
- Département d'Hépato Gastro Entérologie, AP-HP Nord, Hôpital Louis Mourier, Colombes, France
| | - Rachida Lebtahi
- Service de Médecine nucléaire, AP-HP Nord, Université Paris Cité, Hôpital Beaujon, Clichy, France
| | - Henri Duboc
- Département d'Hépato Gastro Entérologie, AP-HP Nord, Hôpital Louis Mourier, Colombes, France
- Centre de recherche sur l'inflammation, INSERM, Université Paris Cité, Paris, France
| | - Marie Dior
- Département d'Hépato Gastro Entérologie, AP-HP Nord, Hôpital Louis Mourier, Colombes, France
| | - Benoit Coffin
- Département d'Hépato Gastro Entérologie, AP-HP Nord, Hôpital Louis Mourier, Colombes, France
- Centre de recherche sur l'inflammation, INSERM, Université Paris Cité, Paris, France
| | - Heithem Soliman
- Département d'Hépato Gastro Entérologie, AP-HP Nord, Hôpital Louis Mourier, Colombes, France
- Centre de recherche sur l'inflammation, INSERM, Université Paris Cité, Paris, France
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Georgiou MF, Sfakianaki E, Diaz-Kanelidis MN, Moshiree B. Gastric Emptying Scintigraphy Protocol Optimization Using Machine Learning for the Detection of Delayed Gastric Emptying. Diagnostics (Basel) 2024; 14:1240. [PMID: 38928655 PMCID: PMC11202747 DOI: 10.3390/diagnostics14121240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2024] [Revised: 06/01/2024] [Accepted: 06/10/2024] [Indexed: 06/28/2024] Open
Abstract
PURPOSE The purpose of this study is to examine the feasibility of a machine learning (ML) system for optimizing a gastric emptying scintigraphy (GES) protocol for the detection of delayed gastric emptying (GE), which is considered a primary indication for the diagnosis of gastroparesis. METHODS An ML model was developed using the JADBio AutoML artificial intelligence (AI) platform. This model employs the percent GE at various imaging time points following the ingestion of a standardized radiolabeled meal to predict normal versus delayed GE at the conclusion of the 4 h GES study. The model was trained and tested on a cohort of 1002 patients who underwent GES using a 70/30 stratified split ratio for training vs. testing. The ML software automated the generation of optimal predictive models by employing a combination of data preprocessing, appropriate feature selection, and predictive modeling analysis algorithms. RESULTS The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was employed to evaluate the predictive modeling performance. Several models were developed using different combinations of imaging time points as input features and methodologies to achieve optimal output. By using GE values at time points 0.5 h, 1 h, 1.5 h, 2 h, and 2.5 h as input predictors of the 4 h outcome, the analysis produced an AUC of 90.7% and a balanced accuracy (BA) of 80.0% on the test set. This performance was comparable to the training set results (AUC = 91.5%, BA = 84.7%) within the 95% confidence interval (CI), demonstrating a robust predictive capability. Through feature selection, it was discovered that the 2.5 h GE value alone was statistically significant enough to predict the 4 h outcome independently, with a slightly increased test set performance (AUC = 92.4%, BA = 83.3%), thus emphasizing its dominance as the primary predictor for delayed GE. ROC analysis was also performed for single time imaging points at 1 h and 2 h to assess their independent predictiveness of the 4 h outcome. Furthermore, the ML model was tested for its ability to predict "flipping" cases with normal GE at 1 h and 2 h that became abnormal with delayed GE at 4 h. CONCLUSIONS An AI/ML model was designed and trained for predicting delayed GE using a limited number of imaging time points in a 4 h GES clinical protocol. This study demonstrates the feasibility of employing ML for GES optimization in the detection of delayed GE and potentially shortening the protocol's time length without compromising diagnostic power.
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Affiliation(s)
- Michalis F. Georgiou
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | - Efrosyni Sfakianaki
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
| | | | - Baha Moshiree
- Atrium Health, Wake Forest University, Charlotte, NC 28204, USA
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Banks KP, Revels JW, Tafti D, Moshiri M, Shah N, Moran SK, Wang SS, Solnes LB, Sheikhbahaei S, Elojeimy S. Scintigraphy of Gastrointestinal Motility: Best Practices in Assessment of Gastric and Bowel Transit in Adults. Radiographics 2024; 44:e230127. [PMID: 38814800 DOI: 10.1148/rg.230127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024]
Abstract
Various radiologic examinations and other diagnostic tools exist for evaluating gastrointestinal diseases. When symptoms of gastrointestinal disease persist and no underlying anatomic or structural abnormality is identified, the diagnosis of functional gastrointestinal disorder is frequently applied. Given its physiologic and quantitative nature, scintigraphy often plays a central role in the diagnosis and treatment of patients with suspected functional gastrointestinal disorder. Most frequently, after functional gallbladder disease is excluded, gastric emptying scintigraphy (GES) is considered the next step in evaluating patients with suspected gastric motility disorder who present with upper gastrointestinal symptoms such as dyspepsia or bloating. GES is the standard modality for detecting delayed gastric emptying (gastroparesis) and the less commonly encountered clinical entity, gastric dumping syndrome. Additionally, GES can be used to assess abnormalities of intragastric distribution, suggesting specific disorders such as impaired fundal accommodation or antral dysfunction, as well as to evaluate gastric emptying of liquid. More recently, scintigraphic examinations for evaluating small bowel and large bowel transit have been developed and validated for routine diagnostic use. These can be performed individually or as part of a comprehensive whole-gut transit evaluation. Such scintigraphic examinations are of particular importance because clinical assessment of suspected functional gastrointestinal disorder frequently fails to accurately localize the site of disease, and those patients may have motility disorders involving multiple portions of the gastrointestinal tract. The authors comprehensively review the current practice of gastrointestinal transit scintigraphy, with diseases and best imaging practices illustrated by means of case review. ©RSNA, 2024 See the invited commentary by Maurer and Parkman in this issue.
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Affiliation(s)
- Kevin P Banks
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Jonathan W Revels
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Dawood Tafti
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Mariam Moshiri
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Neal Shah
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Shamus K Moran
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Sherry S Wang
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Lilja B Solnes
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Sara Sheikhbahaei
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
| | - Saeed Elojeimy
- From the Department of Radiology, San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr, San Antonio, TX 78234 (K.P.B., D.T.); Department of Radiology, Uniformed Services University of the Health Sciences, Bethesda, Md (K.P.B., D.T.); Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC (J.W.R., M.M., N.S.); Department of Radiology, Vanderbilt University Medical Center, Nashville, Tenn (S.K.M.); Department of Radiology, University of Washington, Seattle, Wash (S.S.W.); Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Md (L.B.S., S.S.); and Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah (S.E.)
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Qutbi M, Ahmadi R, Hosseinzadeh E, Asadi A. Gastric Emptying Scintigraphy: Diagnostic Value of Delayed Imaging and the Impact on Reclassification of Diagnosis. Mol Imaging Radionucl Ther 2023; 32:117-122. [PMID: 37337772 PMCID: PMC10284173 DOI: 10.4274/mirt.galenos.2021.65902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/15/2021] [Indexed: 06/21/2023] Open
Abstract
OBJECTIVES To investigate the added diagnostic value of delayed imaging at 3 and 4 h compared to 2 h imaging as well as scanning up to 4 h compared to 3, and by this means, diagnosis reclassification or changes in diagnosis across various time points. METHODS Seventeen patients clinically suspected of gastroparesis, 8 (47.1%) men and 9 (52.9%) women, according to the standard procedural guidelines, underwent gastric emptying scintigraphy after ingesting a standard meal. One-minute static images in anterior and posterior projections were acquired immediately after ingestion and then at 1-, 2-, 3- , and 4 h time points. For image analysis, a manual region-of-interest was drawn, and then, count of stomach in each projection was used to calculate geometric mean for each time point. Decay correction was applied. At 2-, 3- and 4 h time points, percentage of retained activity was compared to standard values; therefore, each patient was labeled as normal or delayed. RESULTS Pairwise correlation between time points was statistically significant. Value of hour 3 shows an extremely strong correlation with the value of hour 4 (r=0.951, p<0.001). In hour 2, of 17 participants, 11 (64.7%) were diagnosed as normal and 6 (35.3%) as delayed. In hour 3, the diagnosis made as delayed rose to 9 (52.9%), whereas normal was 8 (47.1%). Finally, in hour 4, results were 10 (58.8%) as delayed and 7 (41.2%) as normal. All subjects who were labeled as delayed in hour 3 remained with the same diagnosis and 1 out of 8 subjects categorized as normal in hour 3 changed to delayed. For testing agreement, coefficient of kappa was computed between each pair. Agreement between diagnosis in hour 2 with hours 3 or 4 was not strong (kappa <0.6 for both pairs). However, a strong agreement was found between diagnosis in hours 3 and 4 (kappa: 0.881). CONCLUSION Because of excellent correlation between values of hours 3 and 4 and strong agreement between the diagnosis in those time points, extending acquisition from 3 to 4 h adds little to the final dai gnosis and may not be noticeably meaningful, especially in the clinical setting.
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Affiliation(s)
- Mohsen Qutbi
- Department of Nuclear Medicine, Taleghani Hospital Clinical Research Development Unit, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reyhane Ahmadi
- Department of Nuclear Medicine and Molecular Imaging, Farshchian Heart Center, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran
| | - Elinaz Hosseinzadeh
- Department of Nuclear Medicine, Taleghani Hospital Clinical Research Development Unit, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Ali Asadi
- Department of Nuclear Medicine, Taleghani Hospital Clinical Research Development Unit, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Shah H, Sundar R, Prado DEA, Dong JW, Chow DZ, Kuo B, Voss SD, Jacene HA, Robertson MS, Ng TSC. Standard Adult Gastric Emptying Scintigraphy Criteria Is Applicable for Partial Meal Ingestion. Dig Dis Sci 2023; 68:541-553. [PMID: 35995883 DOI: 10.1007/s10620-022-07667-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 08/09/2022] [Indexed: 12/09/2022]
Abstract
BACKGROUND/AIMS Gastric emptying scintigraphy is commonly performed to assess for dysmotility. A standardized meal with associated threshold criteria was established in 2000 to enable robust interpretation. However, no guidance is available to interpret results when patients do not ingest the entire meal. The purpose of this study is to determine the continued appropriateness of the threshold criteria in contemporary clinical practice and its relevance for partially ingested meals. METHODS This retrospective study analyzed patients (n = 1365 total) who underwent solid-phase gastric emptying scintigraphy at an academic medical center. Patients were stratified based on their completion of the standard meal. Patients were further stratified into normal and delayed gastric emptying cohorts based on the current criteria. Percent gastric retention values at 1, 2, 3, and 4 h were compared. RESULTS Median (95% upper reference) normal gastric retention values for the complete standard meal were 64% (87%) at 1 h, 25% (60%) at 2 h, 13% (54%) at 3 h and 4% (9%) at 4 h. Consumption of at least 50% of the standard meal yielded similar retention; 53% (86%) at 1 h, 19% (58%) at 2 h, 6% (29%) at 3 h and 3% (10%) at 4 h. There was no significant age- or gender-specific differences using the current criteria, and no differences were observed based on diabetic status. Retention values matched well with the current criteria and validated with data-driven clustering. CONCLUSION Adult normative standards for gastric emptying scintigraphy are appropriate for differentiating normal and delayed populations and can be applied to partial meals with at least 50% completion.
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Affiliation(s)
- Hina Shah
- Joint Program in Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02114, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 405 Brookline Ave, Boston, MA, 02114, USA
| | - Reethy Sundar
- Brandeis University, 415 South St, Waltham, MA, 02453, USA
| | - David E Arboleda Prado
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Boston, MA, 02115, USA
| | - Jian W Dong
- Joint Program in Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02114, USA
| | - David Z Chow
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 427, Boston, MA, 02115, USA
| | - Braden Kuo
- Division of Gastroenterology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, Boston, MA, 02115, USA
| | - Stephan D Voss
- Joint Program in Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02114, USA
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA
| | - Heather A Jacene
- Joint Program in Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02114, USA
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 405 Brookline Ave, Boston, MA, 02114, USA
| | - Matthew S Robertson
- Joint Program in Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02114, USA
| | - Thomas S C Ng
- Joint Program in Nuclear Medicine, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02114, USA.
- Department of Imaging, Dana-Farber Cancer Institute, Harvard Medical School, 405 Brookline Ave, Boston, MA, 02114, USA.
- Center for Systems Biology, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge St, Boston, MA, 02115, USA.
- Division of Nuclear Medicine and Molecular Imaging, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 427, Boston, MA, 02115, USA.
- Department of Radiology, Boston Children's Hospital, Harvard Medical School, 300 Longwood Ave, Boston, MA, 02115, USA.
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Hosseini S, Avci R, Paskaranandavadivel N, Suresh V, Cheng LK. Quantification of the Regional Properties of Gastric Motility Using Dynamic Magnetic Resonance Images. IEEE OPEN JOURNAL OF ENGINEERING IN MEDICINE AND BIOLOGY 2023; 4:38-44. [PMID: 37138590 PMCID: PMC10151011 DOI: 10.1109/ojemb.2023.3261224] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 01/16/2023] [Accepted: 03/14/2023] [Indexed: 05/05/2023] Open
Abstract
Goal: To quantify the regional properties of gastric motility from free-breathing dynamic MRI data. Methods: Free-breathing MRI scans were performed on 10 healthy human subjects. Motion correction was applied to reduce the respiratory effect. A stomach centerline was automatically generated and used as a reference axis. Contractions were quantified and visualized as spatio-temporal contraction maps. Gastric motility properties were reported separately for the lesser and greater curvatures in the proximal and distal regions of the stomach. Results: Motility properties varied in different regions of the stomach. The mean contraction frequencies for the lesser and greater curvatures were both 3.1±0.4 cycles per minute. The contraction speed was significantly higher on the greater curvature than the lesser curvature (3.5±0.7 vs 2.5±0.4 mm/s, p<0.001) while contraction size on both curvatures was comparable (4.9±1.2 vs 5.7±2.4 mm, p = 0.326). The mean gastric motility index was significantly higher in the distal greater curvature (28.13±18.89 mm2/s) compared to the other regions of the stomach (11.16-14.12 mm2/s). Conclusions: The results showed the effectiveness of the proposed method for visualization and quantification of motility patterns from MRI data.
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Affiliation(s)
- Saeed Hosseini
- Auckland Bioengineering InstituteUniversity of Auckland Auckland 1010 New Zealand
- Riddet Institute Palmerston North 4474 New Zealand
| | - Recep Avci
- Auckland Bioengineering InstituteUniversity of Auckland Auckland 1010 New Zealand
| | | | - Vinod Suresh
- Auckland Bioengineering InstituteUniversity of Auckland Auckland 1010 New Zealand
- Department of Engineering ScienceUniversity of Auckland Auckland 1010 New Zealand
| | - Leo K Cheng
- Auckland Bioengineering InstituteUniversity of Auckland Auckland 1010 New Zealand
- Riddet InstitutePalmerston North 4474 New Zealand
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11
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Arca KN, Cai J, Wang F, Kassim G, Hasler WL, Batheja MJ. Migraine and Gastroparesis. Curr Neurol Neurosci Rep 2022; 22:813-821. [PMID: 36370318 DOI: 10.1007/s11910-022-01241-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/30/2022] [Indexed: 11/15/2022]
Abstract
PURPOSEOF REVIEW Migraine is a chronic and disabling disease affecting a significant proportion of the world's population. There is evidence that gastroparesis, a gastrointestinal (GI) dysmotility disorder in which transit of gastric contents is delayed, can occur in the setting of migraine. This article aims to review recent literature on overlap in the pathophysiology and clinical manifestations of migraine and gastroparesis and highlight management considerations when these disorders coexist. RECENT FINDINGS There has been increasing recognition of the importance of the connection between the GI tract and the brain, and mounting evidence for the overlap in the pathophysiology of migraine and gastroparesis specifically. There exists a complex interplay between the central, autonomic, and enteric nervous systems. Studies show that gastroparesis may be present during and between acute migraine attacks necessitating modification of management to optimize outcomes. Gastric dysmotility in the setting of migraine can impact absorption of oral migraine medications and alternate formulations should be considered for some patients. Noninvasive vagus nerve stimulation has been FDA cleared for migraine treatment and is also being studied in gastroparesis. Dysfunction of the autonomic nervous system is a significant feature in the pathophysiology of gut motility and migraine, making treatments that modulate the vagus nerve attractive for future research.
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Affiliation(s)
- Karissa N Arca
- Department of Neurology, Mayo Clinic Arizona, Scottsdale, AZ, USA.
| | - Jacqueline Cai
- Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Fangfang Wang
- Department of Internal Medicine, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Gassan Kassim
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - William L Hasler
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Mashal J Batheja
- Department of Gastroenterology, Mayo Clinic Arizona, Scottsdale, AZ, USA
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12
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Gardella R, Silver PJ, Shahsavari D, Maurer AH, Parkman HP. Gastric half emptying time (T ½ ) for 4-h gastric emptying scintigraphy simplifies reporting but reduces detection of gastroparesis. Neurogastroenterol Motil 2022; 34:e14261. [PMID: 34633719 DOI: 10.1111/nmo.14261] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 08/29/2021] [Accepted: 08/30/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND Gastric emptying scintigraphy (GES) reports percent retention at 1, 2, and 4 h. Time to empty half the meal (T½ ) could simplify GE reporting. AIMS To compare the performance of GES T½ to 1-, 2-, and 4-h retention. METHODS GES studies were reviewed; results determined according to retention at 1, 2, and 4 h. T½ was determined using 3 methods: (1) GES curve fitting using 0, 0.5, 1, 2, 3, and 4 h data; (2) linear interpolation using 0, 0.5, 1, 2, 3, and 4 h data; and (3) linear interpolation using only 0, 1, 2, and 4 h data. RESULTS Of 495 patients, 265 had normal GE, 4 rapid GE (<30% retention at 1 h), and 226 delayed GE: 17 delayed only at 2 h (>60% ret); 94 delayed only at 4 h (>10% ret); and 115 delayed at both 2 h and 4 h. Strong correlations were seen between each T½ method and 1, 2, 3, and 4 h %-empty values: curve-fit T½ (r = -0.851, -0.942, -0.864, -0.744), linear T½ using all imaging times (r = -0.848, -0.972, -0.878, -0.763), and linear T½ using standard imaging times (r = -0.853, -0.974, -0.868, -0.760). The 132 min cutoff for delayed GE captures 99.1% to 100% of delayed GE at both 2 h and 4 h, 76.5% to 94.1% delayed at 2 h only, but only 36.7% to 39.4% delayed at 4 h only; 3.5 to 11.3% of patients with normal GE miscategorized as delayed. CONCLUSIONS GES T½ correlates more strongly with retention at 2 h than at 4 h. T½ alone may misclassify patients, particularly those with late-phase (4 h only) delays, reducing its utility for diagnosing gastroparesis.
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Affiliation(s)
- Rebecca Gardella
- Lewis Katz School of Medicine at, Temple University, Philadelphia, Pennsylvania, USA
| | - Paul J Silver
- Department of Gastroenterology, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Dariush Shahsavari
- Department of Gastroenterology, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Alan H Maurer
- Department of Gastroenterology, Temple University Health System, Philadelphia, Pennsylvania, USA.,Department of Radiology, Temple University Health System, Philadelphia, Pennsylvania, USA
| | - Henry P Parkman
- Department of Gastroenterology, Temple University Health System, Philadelphia, Pennsylvania, USA
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13
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Early steps of an alternative test meal for gastric emptying scintigraphy. VOJNOSANIT PREGL 2022. [DOI: 10.2298/vsp211121052s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Background/Aim. Gastric emptying (GE) scintigraphy provides a physiologic and noninvasive measurement of GE. Although GE scintigraphy has been standardized, preparing a meal is still complex and not practical in daily routine. The aim of the study was to prepare a simple, practical, and easily standardizable semisolid meal and investigate its role in estimating the GE function in of rabbits. Methods. In the first part of the study (basal condition), the mixture of the macroaggregated albumin (MAA) labeled with 37 MBq (1 mCi) of technetium-99m (99mTc) and 40 g of barium sulfate (1g/mL) was applied to animals via a nasogastric catheter. A series of images (frame/min, 60 min) in the anterior and posterior projections were dynamically acquired, and the motion was corrected after the radiopharmaceutical application. A few days later, the same rabbits were scanned under the same protocol after a 1 mg atropine injection to simulate gastroparesis condition. Eleven rabbits were included according to inclusion and exclusion criteria, and a total of twenty-two imaging data sets were analyzed for quantification. Results. In the basal study, total counts of the mixture decreased from 87,800.83 ? 12,622.76 to 42,733.14 ? 6,591.53 at 30 min and to 13,684.19 ? 1,774.90 at 60 min, and these decreases were statistically significant (p = 0.003). Emptying percentages were 51.39 ? 0.78% at 30 min and 84.32 ? 1.56 at 60 min and were statistically significant (p = 0.003). After intravascular atropine sulfate injection, total counts of the mixture decreased from 84,508.78 ? 11,871.48 to 64,995.18 ? 9,298 at 30 min and to 53,507.17 ? 7,258.98 at 60 min, and these decreases were statistically significant (p = 0.003). Emptying percentages were 23.10 ? 1.11% at 30 min and 36.63 ? 1.42 at 60 min and were statistically significant (p = 0.003). The difference between basal and post-atropine sulfate gastric emptying percentage at 30th (p = 0.003) and 60th (p = 0.003) min was statistically significant. Conclusion. The meal, used in this study, is non-nutrient, fatty-free, and semisolid and is easy to prepare and administer. Due to its semisolid nature, it offers a chance to evaluate the quantification of regional and total GE as well as the separate roles of the fundus and antrum.
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14
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Wise JL, Vazquez-Roque MI, McKinney CJ, Zickella MA, Crowell MD, Lacy BE. Gastric Emptying Scans: Poor Adherence to National Guidelines. Dig Dis Sci 2021; 66:2897-2906. [PMID: 32418002 DOI: 10.1007/s10620-020-06314-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Accepted: 05/02/2020] [Indexed: 12/18/2022]
Abstract
BACKGROUND Accurately diagnosing gastroparesis relies upon gastric emptying scintigraphy (GES) being performed correctly. Jointly published protocol guidelines have long been available; however, the extent to which practitioners adhere to these guidelines is unknown. AIMS This study aimed to assess national compliance with established GES protocol guidelines. METHODS We developed a questionnaire addressing the key protocol measures outlined in the Consensus Recommendations for Gastric Emptying Scintigraphy. Survey questions addressed patient information collection (15), patient preparation and procedure protocol (16), meal content and preparation (7), imaging (3), interpretation (4), reporting (7), and institutional demographic data (7). The anonymous questionnaire was distributed electronically to members of the Society of Nuclear Medicine and Medical Imaging (SNMMI) and non-member recipients of the SNMMI daily email newsletter. One response per medical institution was permitted. RESULTS A total of 121 out of 872 potential medical institutions (MI) responded (13.9%); 49 (40.4%) were academic/teaching medical centers. The annual number (mean) of GES procedures was 199.9 (range 5-2000 GES/year). On average, MI performed 33.5/52 (64%) of protocol measures according to guidelines while academic medical centers performed 31.5/52 (61%) of protocol measures according to guidelines. Only 4 out of 88 MI (4.5%) performed GES while adhering to three critical measures: validated study duration; controlled blood glucose levels; and proper restriction of medications. CONCLUSIONS Low compliance with GES protocol guidelines, even among academic medical centers, raises the likely possibility of misdiagnosis and improper management of upper gastrointestinal symptoms. These results highlight a need for increased awareness of protocol guidelines for gastric scintigraphy.
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Affiliation(s)
- Journey L Wise
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Maria I Vazquez-Roque
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Caleb J McKinney
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael A Zickella
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Michael D Crowell
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, AZ, USA
| | - Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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15
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Kovacic K, Zhang L, Nugent Liegl M, Pawela L, Simpson P, Sood MR. Gastric emptying in healthy children using the Spirulina breath test: The impact of gender, body size, and pubertal development. Neurogastroenterol Motil 2021; 33:e14063. [PMID: 33300658 DOI: 10.1111/nmo.14063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/10/2020] [Accepted: 11/17/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND There are no pediatric norms for gastric emptying (GE) measured by nuclear scintigraphy. The 13 C-labeled, stable isotope GE breath test (GEBT) is a non-radioactive alternative. We aimed to determine normative GEBT ranges in a cohort of healthy children and examine the influence of age, gender, puberty, and body surface area (BSA). METHODS Healthy children ages 8-18 years completed the [13 C]-Spirulina platensis GEBT after an overnight fast. Breath samples were collected at baseline, every 15 min × 1 h, then every 30 min for 4 h total. The 13 CO2 excretion rate was determined by the change in 13 CO2 /12 CO2 over time in each breath sample, expressed as kPCD (Percent 13 C Dose excreted/min). A mixed model with random time was used for multivariable analysis and outcome fit into a quadratic model. KEY RESULTS The 100 subjects completed the test meal within allotted time. Median (IQR) age was 13.5 (11.3-15.5) years; 51% were female. Females had lower 13 CO2 excretion rates (slower GE) than males across time (p < 0.001) while decreased excretion rates correlated with higher BSA (p = 0.015). Gender differences were also noted within pubertal stages with females showing slower GE. Multivariable analysis suggested that pre-pubertal children have faster GE than both peri- and post-pubertal groups (p < 0.0001). CONCLUSIONS & INFERENCES Gender, puberty, and BSA influence GE rates in healthy children more than age. Although further data are needed, pubertal stage and hormonal influences may be unique factors to consider when assessing GE in children.
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Affiliation(s)
- Katja Kovacic
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Liyun Zhang
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Melodee Nugent Liegl
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Louis Pawela
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Pippa Simpson
- Division of Quantitative Health Sciences, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Manu R Sood
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
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Wolfson S, Wilhelm Z, Opekun AR, Orth R, Shulman RJ, Chumpitazi BP. Clinical Characterization of Pediatric Gastroparesis Using a Four-hour Gastric Emptying Scintigraphy Standard. J Pediatr Gastroenterol Nutr 2021; 72:848-853. [PMID: 33605658 PMCID: PMC8486321 DOI: 10.1097/mpg.0000000000003089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
OBJECTIVES Four-hour gastric emptying scintigraphy (GES) is the recommended method to identify both adult and childhood gastroparesis (GP). Previous pediatric studies have, however, not used this standard. We sought to determine the characteristics and outcomes of children versus adolescents with GP using the 4-hour GES evaluation. METHODS We performed a retrospective chart review of pediatric patients diagnosed with GP by 4-hour GES (>10% retention at 4 hours). Demographics, body mass index, GP-related symptoms, comorbidities, etiologies, therapies (eg, medications), healthcare utilization, and response to therapy were captured systematically. Symptoms were compared from the initial versus last gastroenterology visit. Outcomes were categorized as no improvement; improvement (resolution of at least 1 symptom while remaining on therapy); and complete resolution of symptoms. RESULTS A total of 239 subjects (12.1 ± 4.1 years [mean ± standard deviation], 70% girls) were included. The identified characteristics of childhood GP were broad with idiopathic GP being the most common etiology. Outcomes over a median of 22 months (25%-75%: 9.0-45.5 months) were 34.8% no improvement, 34.8% some improvement, and 30.3% with complete symptom resolution. Compared to younger children, adolescents had a higher female predominance (P < 0.01) and were more likely to have nausea (P = 0.006). Girls were more likely to have abdominal pain (P = 0.001), nausea (P = 0.03), and a documented diagnosis of dysautonomia (P = 0.03). Boys were more likely to have regurgitation (P = 0.006), gastroesophageal reflux disease (P = 0.02), and rumination (P = 0.02). CONCLUSIONS Using the 4-hour GES standard, childhood GP has broad clinical characteristics and outcomes. There are several significant age- and sex-based differences in childhood GP.
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Affiliation(s)
- Sharon Wolfson
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, PA USA
| | - Zoe Wilhelm
- Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Antone R. Opekun
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Department of Medicine, Baylor College of Medicine, Houston, TX USA
| | - Robert Orth
- Department of Radiology, Children’s Hospital of Wisconsin
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX USA
| | - Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Houston, TX USA
- Children’s Nutrition Research Center, United States Department of Agriculture, Houston, TX USA
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17
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Shava U, Srivastava A, Mathias A, Kumar N, Yachha SK, Gambhir S, Poddar U. Functional dyspepsia in children: A study of pathophysiological factors. J Gastroenterol Hepatol 2021; 36:680-686. [PMID: 32710649 DOI: 10.1111/jgh.15193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/14/2020] [Accepted: 07/18/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIM Functional dyspepsia (FD) is common in children, and treatment targeted towards the altered pathophysiology can improve outcome. We evaluated FD children for abnormality of gastric accommodation and emptying, psychological stressors (PS), Helicobacter pylori (HP) infection, and post-infectious FD. METHODS Diagnosis of FD was based on ROME III criteria. Clinical evaluation including dyspeptic symptom scoring and assessment for PS was performed. Satiety drink test for gastric accommodation, gastroscopy with biopsy for HP infection, and solid meal gastric emptying were performed. Sixty-seven healthy children were enrolled for assessing PS and satiety drink test. RESULTS Fifty-five FD children (33 boys, age 12 [6-18] years) with symptoms for 4 (2-48) months and dyspeptic score of 5 (1-13) were enrolled. PS were more common in FD than in controls (46/55 vs 9/67; P < 0.001). Median satiety drink volume was 360 mL (180-1320 mL); no patients had satiety drink volume of < 5th centile of healthy children. The frequency (98% vs 85%; P = 0.01) and severity (65 [10-175] vs 50 [5-130]; P < 0.001) of postprandial symptoms were higher in FD than in controls. Of the postprandial symptoms, pain (20.3% vs 0%; P = 0.000) was present only in FD. Delayed gastric emptying was present in 6.5%, HP infection in 11%, and post-infectious FD in 13% cases. Etiological factor was identified in 87% children, with 20% having multiple factors. CONCLUSIONS Abnormality of gastric sensorimotor function is seen in one-fourth of FD cases. HP infection and post-infectious FD are present in 11% and 13% cases, respectively.
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Affiliation(s)
- Upender Shava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Anshu Srivastava
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Amrita Mathias
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Narvesh Kumar
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Surender Kumar Yachha
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Sanjay Gambhir
- Department of Nuclear Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
| | - Ujjal Poddar
- Department of Pediatric Gastroenterology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India
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Rangan V, Ukleja A. Gastroparesis in the Hospital Setting. Nutr Clin Pract 2021; 36:50-66. [PMID: 33336872 DOI: 10.1002/ncp.10611] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/04/2020] [Indexed: 12/15/2022] Open
Abstract
Gastroparesis (GP) is commonly seen in hospitalized patients. Refractory vomiting and related dehydration, electrolyte abnormalities, and malnutrition are indications for hospital admission. In addition, tube feeding intolerance is a common sign of gastric dysmotility in critically ill patients. The diagnosis and management of GP in the hospital setting can be quite challenging. Diagnostic tests are often deferred because of patient intolerance of the oral meal for standard scintigraphy or severity of the primary disease. The diagnosis of GP is often established on the basis of clinical scenario and risk factors for gastric motor dysfunction. Medical therapy in GP is directed toward controlling nausea and vomiting by prokinetic and antinausea medications and correcting nutrition risks or treating malnutrition with nutrition therapy. Enteral nutrition is the preferred nutrition intervention for patients with GP. Delayed gastric emptying in critically ill patients has a negative impact on the timely delivery of enteral feeding and meeting the energy and protein goals. Measures to improve gastric tolerance or provide feeding beyond the stomach are often needed, since early enteral nutrition has been an important target of therapy for critically ill patients. This review will address the current understanding of the mechanisms of GP and feeding intolerance in critical illness, diagnostic workup, drug therapies, and interventions to improve the provision of enteral nutrition in hospital settings when gastric dysmotility is present or suspected.
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Affiliation(s)
- Vikram Rangan
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Ukleja
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
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19
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Gastroparesis and Severity of Delayed Gastric Emptying: Comparison of Patient Characteristics, Treatments and Medication Adverse Events. Dig Dis Sci 2021; 66:526-534. [PMID: 32306190 DOI: 10.1007/s10620-020-06258-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 04/08/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Gastroparesis is a heterogeneous disorder. Patient characteristics and treatment responsiveness may differ based on the extent of delay in gastric emptying. AIMS Characterize gastroparesis patients based on the degree of delay in gastric emptying, and assess the relationship of patient demographics, symptoms and response to therapy based on the extent of delay. METHODS 1333 solid-phase 4-h scintigraphic gastric emptying scans were reviewed. Delayed emptying was categorized on percent retention at 4 h: mild (10-19%), moderate (20-29%), and severe (≥ 30%). Analyses were performed with regard to demographics, symptoms, esophagogastroduodenoscopy findings, medication use, and emergency department (ED) visits/hospitalizations. RESULTS 284 patients had delayed gastric emptying: mild (42.6%), moderate (19.3%), and severe (37.3%). 79.5% were women, the mean age was 45 years (± 15), and mean symptom duration was 4.6 years (± 6.5). The main categories of gastroparesis were idiopathic and diabetes mellitus. The most commonly prescribed medications were metoclopramide, domperidone and erythromycin. Opiate use (n = 69) was associated with an increased degree of delayed gastric emptying (p = 0.03) with 50% of opiate users having very delayed gastric emptying. One-way analysis revealed that severely delayed gastric emptying correlated with both increased hospitalizations and ED visits. CONCLUSIONS Severe delay in gastric emptying is a risk factor for increased hospitalizations and ED visits. Opiate use correlates with increased severity of gastric emptying. Identifying at-risk patients, stopping opioids, and instituting a programmatic care plan for patients with severely delayed gastric emptying may reduce ED visits, hospitalizations, and healthcare costs.
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Carlin JL, Lieberman VR, Dahal A, Keefe MS, Xiao C, Birznieks G, Abell TL, Lembo A, Parkman HP, Polymeropoulos MH. Efficacy and Safety of Tradipitant in Patients With Diabetic and Idiopathic Gastroparesis in a Randomized, Placebo-Controlled Trial. Gastroenterology 2021; 160:76-87.e4. [PMID: 32693185 DOI: 10.1053/j.gastro.2020.07.029] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 07/13/2020] [Accepted: 07/15/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND & AIMS Treatments are needed for gastroparesis; antagonists of tachykinin receptor 1 (TACR1, also called NK1R) can reduce symptoms of nausea and vomiting. We investigated the safety and efficacy of tradipitant, an antagonist of NK1R, in patients with idiopathic or diabetic gastroparesis. METHODS We performed a double-blind trial of 152 adults with gastroparesis at 47 sites in the United States from November 2016 through December 2018. Participants were randomly assigned to groups given oral tradipitant 85 mg (n = 77) or placebo (n = 75) twice daily for 4 weeks. Symptoms were assessed by a daily symptom dairy, Gastroparesis Cardinal Symptom Index scores, and other patient-reported questionnaires. The primary outcome from the intent-to-treat analysis was change from baseline to week 4 in average nausea severity, measured by the Gastroparesis Core Symptom Daily Diary. RESULTS Patients receiving tradipitant had a significant decrease in nausea score (reduction of 1.2) at week 4 compared with placebo (reduction of 0.7) (P = .0099) and a significant increase in of nausea-free days at week 4 (28.8% increase on tradipitant vs 15.0% on placebo; P = .0160). Patients with nausea and vomiting at baseline (n = 101) had an even greater decrease in nausea in when given tradipitant (reduction of 1.4) compared with those given placebo (reduction of 0.4) (P < .0001), as well as an increase in nausea-free days at week 4 (32.3% improvement on tradipitant vs 7.6% on placebo; P = .0003). The average nausea score was 1 or less at week 4 in 32.9% of patients given tradipitant compared with 11.8% of patients given placebo (P = .0013). A greater than 1-point improvement in Gastroparesis Cardinal Symptom Index score was observed in 46.6% of patients given tradipitant compared with 23.5% of patients given placebo (P = .0053). CONCLUSIONS Tradipitant resulted in statistically and clinically meaningful improvements in nausea and reduced vomiting, compared with placebo, in patients with idiopathic or diabetic gastroparesis. ClinicalTrials.gov, Number: NCT02970968.
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Affiliation(s)
| | | | - Arya Dahal
- Vanda Pharmaceuticals, Inc, Washington, DC
| | | | | | | | - Thomas L Abell
- Division of Gastroenterology, Hepatology and Nutrition, Department of Internal Medicine, University of Louisville, Louisville, Kentucky
| | - Anthony Lembo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts
| | - Henry P Parkman
- Department of Medicine, Temple University School of Medicine, Philadelphia, Pennsylvania
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21
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Gajsek U, Sieber A, Finderle Z. Thermal balance of spinal cord injured divers during cold water diving: A case control study. Diving Hyperb Med 2020; 50:256-263. [PMID: 32957128 DOI: 10.28920/dhm50.3.256-263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 06/17/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION This study compared the thermal balance of spinal cord injured (SCI) divers and able-bodied (AB) divers during recreational cold-water dives. METHODS Ten divers (5 AB, 5 SCI) in matched pairs dived in a shallow lake (temperature 6°C) for 30 to 36 min wearing 5 mm 'Long John' neoprene wetsuits. A gastrointestinal temperature radio pill recorded gastro-intestinal temperature (Tgi) prior to, immediately after and at 5, 10, 15, 30, 60, 120 min post-dive. Subjective ratings of temperature perception were recorded concomitantly using a visual analogue scale (VAS). RESULTS No difference between SCI and AB divers in Tgi before the dive was observed (P = 0.85). After the dive, SCI divers cooled significantly more than AB at all measured time intervals (P < 0.001). Post dive, the mean maximum fall in Tgi during the recovery phase in SCI divers was 0.85°C (SD 0.20) and in the AB group was 0.48°C (0.48). In addition, there was greater individual variation in SCI divers compared to AB divers. There were no statistically significant differences in temperature perception between the groups either before or at any time after the dives. CONCLUSIONS In contrast to AB divers, divers with SCI were unable to maintain Tgi during short shallow dives in 6°C water and their temperatures fell further post-dive. The reduction in Tgi was not reflected in the subjective ratings of temperature perception by the SCI divers. The study was too small to assess how the level of spinal injury influenced thermal balance.
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Affiliation(s)
- Urska Gajsek
- Department of Diving and Hyperbaric Medicine, Prince of Wales Hospital, Sydney, Australia.,Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Corresponding aurthor: Urska Gajsek, Department of Abdominal and General Surgery, University Clinical Center Maribor Ljubljanska 5, 2000 Maribor, Slovenia,
| | - Arne Sieber
- Seabear Diving Technology, Leoben, Austria.,Chalmers University of Technology, Gothenburg, Sweden
| | - Zarko Finderle
- Institute of Physiology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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22
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Maurer AH. Enhancing Scintigraphy for Evaluation of Gastric, Small Bowel, and Colonic Motility. Gastroenterol Clin North Am 2020; 49:499-517. [PMID: 32718567 DOI: 10.1016/j.gtc.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
This article reviews the latest enhancements in standards and technology for performing gastric emptying and associated small bowel and colon transit scintigraphic studies. It discusses how developments in appropriate use criteria, American Medical Association Current Procedural Terminology coding, and advanced commercial software permit clinicians to obtain more comprehensive physiologic studies of gastric, small bowel, and colon gastrointestinal motility disorders. It shows how gastrointestinal scintigraphy has expanded to permit assessments of global and regional (fundic and antral) gastric motility and how it permits a single study (whole-gut transit scintigraphy), including measurement of solid and liquid gastric emptying and small bowel and colon transit.
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Affiliation(s)
- Alan H Maurer
- Department of Radiology, Nuclear Medicine Section, Lewis Katz School of Medicine, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA; Department of Medicine, Gastroenterology Section, Lewis Katz School of Medicine, Temple University Hospital, 3401 North Broad Street, Philadelphia, PA 19140, USA.
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23
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Wellington J, Stuart P, Westcott C, Koch KL. Obstructive Gastroparesis: Patient Selection and Effect of Laparoscopic Pyloroplasty. J Gastrointest Surg 2020; 24:1778-1784. [PMID: 31270719 DOI: 10.1007/s11605-019-04240-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 04/21/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Functional obstructive gastroparesis is an understudied subtype of gastroparesis with normal 3 cycle per minute gastric myoelectrical activity that responds to botulinum toxin A injection and balloon dilation of the pylorus. AIMS To determine the effect of pyloroplasty on symptoms, weight, gastric emptying, and gastric myoelectrical activity in patients with gastroparesis and normal 3 cycle per minute gastric myoelectrical activity. METHODS Ten patients (average age 36 years with gastroparesis and normal 3 cycle per minute gastric myoelectrical activity) who had at least two successful endoscopic pyloric therapies and then underwent pyloroplasty were identified. Electrogastrography with water load satiety test was performed to determine gastric myoelectrical activity. Gastric emptying was measured with 4-h scintigraphy. KEY RESULTS Six months after pyloroplasty, nine of ten patients reported improved symptoms and weight increased an average of 6.4 lb (p = 0.04). The average percentage of meal retained at 4 h decreased from 47% before to 16% after pyloroplasty (p < 0.01) and normalized in six patients. After pyloroplasty, the percent distribution of gastric myoelectrical activity power in the 3 cycle per minute range decreased at each measured interval compared with pre-pyloroplasty (p < 0.01). CONCLUSIONS (1) Pyloroplasty in these patients with obstructive gastroparesis improved gastric emptying and decreased 3 cycle per minute gastric myoelectrical activity, consistent with relief of functional gastric outlet obstruction. (2) Pyloric neuromuscular dysfunction is a key factor in delayed emptying in patients with functional obstructive gastroparesis.
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Affiliation(s)
- Jennifer Wellington
- Section on Gastroenterology, Department of Surgical Services, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA.,Section on Gastroenterology, University of Maryland Medical Center, Baltimore, MD, 21210, USA
| | - Paula Stuart
- Section on Gastroenterology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Carl Westcott
- Section on Gastroenterology, Department of Surgical Services, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA
| | - Kenneth L Koch
- Section on Gastroenterology, Department of Surgical Services, Wake Forest Baptist Medical Center, Winston-Salem, NC, 27157, USA. .,Section on Gastroenterology, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
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24
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Ziessman HA, Jeyasingam M, Khan AU, McMahan Z, Pasricha PJ. Experience with Esophagogastrointestinal Transit Scintigraphy in the Initial 229 Patients: Multiple Regions of Dysmotility Are Common. J Nucl Med 2020; 62:115-122. [PMID: 32482790 DOI: 10.2967/jnumed.120.243527] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 05/05/2020] [Indexed: 11/16/2022] Open
Abstract
The purpose of this investigation was to review our experience with our comprehensive esophagogastrointestinal transit study in the first 229 patients. This scintigraphic study analyzes the motility of the entire gut, from the esophagus through the rectosigmoid colon. Methods: Data were reviewed for our first 2 y of experience with this examination (184 women and 45 men aged 20-79 y [mean ± SD, 44 ± 16 y]). Patients were referred with symptoms suggestive of a motility disorder. They first swallowed 111In-diethylenetriaminepentaacetic acid in water for the esophageal-swallow study and then 300 mL for a 30-min 111In water-only study, followed by 120 mL of 111In water simultaneously with the solid standardized 99mTc egg-substitute meal. Images and quantification were obtained for esophageal transit, water-only gastric emptying, water-with-solid gastric emptying, small-bowel transit, and colonic transit. Results: Of the 229 patient studies, 45 (20%) were normal. The remaining 184 (80%) had at least 1 region of dysmotility, for a total of 336 regions of abnormal motility. A single region of dysmotility was seen in 92 patients (50%), 2 regions in 50 (27%), 3 regions in 26 (14%), 4 regions in 12 (7%), and 5 regions in 4 (2%). There was a poor correlation between the results of the water-only study and water with the solid meal. Three different patterns of delayed colonic transit were seen. Patient symptoms were often not predictive of the scintigraphic findings. Conclusion: This study highlights the frequent occurrence of dysmotility in more than 1 region of the gastrointestinal tract in patients with a suspected motility disorder and the frequent concurrence of both upper- and lower-tract dysmotility in the same patients. It provides information to referring physicians regarding which motility disorders may be causing the patient symptoms, why the patient is or is not responding to the present therapy, and if and what additional workup and therapy may be needed.
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Affiliation(s)
- Harvey A Ziessman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Mathurika Jeyasingam
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahsan U Khan
- Department of Radiology, West Virginia University, Morgantown, West Virginia
| | - Zsuzsanna McMahan
- Division of Rheumatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland; and
| | - Pankaj J Pasricha
- Division of Gastroenterology and Hepatology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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Kovacic K, Elfar W, Rosen JM, Yacob D, Raynor J, Mostamand S, Punati J, Fortunato JE, Saps M. Update on pediatric gastroparesis: A review of the published literature and recommendations for future research. Neurogastroenterol Motil 2020; 32:e13780. [PMID: 31854057 DOI: 10.1111/nmo.13780] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 11/11/2019] [Accepted: 11/29/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Due to scarcity of scientific literature on pediatric gastroparesis, there is a need to summarize current evidence and identify areas requiring further research. The aim of this study was to provide an evidence-based review of the available literature on the prevalence, pathogenesis, clinical presentation, diagnosis, treatment, and outcomes of pediatric gastroparesis. METHODS A search of the literature was performed using the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines with the following databases: PubMed, EMBASE, Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects, Cochrane Central Register of Controlled Trials, and Web of Science. Two independent reviewers screened abstracts for eligibility. KEY RESULTS Our search yielded 1085 original publications, 135 of which met inclusion criteria. Most articles were of retrospective study design. Only 12 randomized controlled trials were identified, all of which were in infants. The prevalence of pediatric gastroparesis is unknown. Gastroparesis may be suspected based on clinical symptoms although these are often non-specific. The 4-hour nuclear scintigraphy scan remains gold standard for diagnosis despite lack of pediatric normative comparison data. Therapeutic approaches include dietary modifications, prokinetic drugs, and postpyloric enteral tube feeds. For refractory cases, intrapyloric botulinum toxin and surgical interventions such as gastric electrical stimulation may be warranted. Most interventions still lack rigorous supportive data. CONCLUSIONS Diagnosis and treatment of pediatric gastroparesis are challenging due to paucity of published evidence. Larger and more rigorous clinical trials are necessary to improve outcomes.
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Affiliation(s)
- Katja Kovacic
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Walaa Elfar
- Division of Gastroenterology and Nutrition, Department of Pediatrics, The Pennsylvania State Melton S. Hershey Medical Center, Hershey, PA, USA
| | - John M Rosen
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, The Children's Mercy Hospital, Kansas City, MO, USA
| | - Desale Yacob
- Division of Gastroenterology, Hepatology, and Nutrition, Nationwide Children's Hospital, Ohio State University, Columbus, OH, USA
| | - Jennifer Raynor
- Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA
| | - Shikib Mostamand
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaya Punati
- Division of Pediatric Gastroenterology, Hepatology, and Nutrition, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - John E Fortunato
- Neurointestinal and Motility Program, Section of Pediatric Gastroenterology, Hepatology and Nutrition, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Miguel Saps
- Division of Pediatric Gastroenterology, Hepatology and Nutrition, Holtz Children's Hospital, Miller School of Medicine, University of Miami, Miami, FL, USA
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26
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Febo‐Rodriguez L, Chumpitazi BP, Shulman RJ. Childhood gastroparesis is a unique entity in need of further investigation. Neurogastroenterol Motil 2020; 32:e13699. [PMID: 31407456 PMCID: PMC7015769 DOI: 10.1111/nmo.13699] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2019] [Revised: 07/23/2019] [Accepted: 07/30/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite increasing knowledge regarding gastroparesis (GP) in adults, little is known regarding the incidence, prevalence, and natural history of childhood GP. Exacerbating the knowledge gap in pediatric GP is both the lack of normative data for gastric emptying scintigraphy in children and lack of GP-specific pediatric reported outcome measures. PURPOSE The aim of this article was to review the available literature on pediatric GP and identify similarities and differences with studies in adults. We performed a comprehensive search in MEDLINE and Google Scholar from inception to April 2019 for articles published in English using the following combination of keywords: gastroparesis, pediatric gastroparesis, outcomes, metoclopramide, erythromycin, domperidone, cisapride, and gastric neurostimulator. The limited available pediatric data, often retrospective, suggest marked differences between adult and pediatric GP in several aspects including etiology, concomitant co-morbidities (eg, psychiatric disorders), clinical symptom presentation, diagnostic evaluation, response to therapies, and clinical outcome. Further research in pediatric GP is needed and holds the promise to further elucidate the mechanisms of this disorder in children and lead to pediatric-focused therapies.
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Affiliation(s)
- Liz Febo‐Rodriguez
- Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Section of Pediatric Gastroenterology, Hepatology, and Nutrition Texas Children's Hospital Houston TX USA
| | - Bruno P. Chumpitazi
- Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Section of Pediatric Gastroenterology, Hepatology, and Nutrition Texas Children's Hospital Houston TX USA
| | - Robert J. Shulman
- Department of Pediatrics, Baylor College of Medicine, Children's Nutrition Research Center, Section of Pediatric Gastroenterology, Hepatology, and Nutrition Texas Children's Hospital Houston TX USA
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27
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Parkman HP, Orthey P, Maurer AH. Gastric Motility. ENCYCLOPEDIA OF GASTROENTEROLOGY 2020:598-612. [DOI: 10.1016/b978-0-12-801238-3.11092-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2025]
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28
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Nuclear Medicine Imaging Techniques of the Gastrointestinal System. Clin Nucl Med 2020. [DOI: 10.1007/978-3-030-39457-8_9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The symptoms of gastroparesis, such as nausea, vomiting, postprandial fullness, early satiety and abdominal pain, frequently impair the quality of life of the affected individuals. The diagnosis of gastroparesis is made after structural etiologies are ruled out and an assessment of gastric function shows delayed gastric emptying. The role of the delay in gastric emptying in the pathogenesis of symptoms of gastroparesis has been debated, with some studies suggesting an association between delayed gastric emptying and the upper gastrointestinal symptoms, while others do not. The recent literature supports the importance of using reliable methods to assess gastric emptying, as delay in gastric emptying measured on a reliable test (4-h scintigraphy or breath test) is associated with the severity of upper gastrointestinal symptoms. In addition to measuring total gastric emptying, evaluation of regional gastric retention in the proximal and distal stomach and whole gut transit to assess small intestinal and colonic transit may provide additional useful information in patients with more generalized symptoms of gastrointestinal dysmotility.
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30
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Lee TH. The Associations Among Symptoms, Quality of Life, and Gastric Emptying: An Unresolved Issue. J Neurogastroenterol Motil 2019; 25:483-486. [PMID: 31587538 PMCID: PMC6786445 DOI: 10.5056/jnm19168] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 09/19/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Tae Hee Lee
- Institute for Digestive Research, Soonchunhyang University Seoul Hospital, Seoul, Korea
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Wuestenberghs F, Juge M, Melchior C, Desprez C, Leroi AM, Gourcerol G. Association Between Symptoms, Quality of Life, and Gastric Emptying in Dyspeptic Patients. J Neurogastroenterol Motil 2019; 25:534-543. [PMID: 31587545 PMCID: PMC6786450 DOI: 10.5056/jnm19060] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 06/25/2019] [Accepted: 07/20/2019] [Indexed: 12/17/2022] Open
Abstract
Background/Aims Association between symptoms, quality of life and gastric emptying in dyspepsia is inconsistent in the literature. The aim of our study is to investigate if gastric emptying is associated with specific symptoms and quality of life in dyspeptic patients. Methods We reviewed retrospectively gastric emptying measured by 13C-labelled octanoate breath testing for more than 6 hours in 198 consecutive patients with dyspepsia complaints. Gastrointestinal symptoms were assessed using a 5-points Likert scale and by a symptomatic composite score, whereas quality of life was measured by the GIQLI. Results In our cohort, 90 patients (45%) had a delayed gastric emptying (half emptying time above 166 minutes when assessed over 6–8 hours). There was no difference in symptoms or quality of life between patients with or without delayed gastric emptying. However, patients with severely delayed gastric emptying (half emptying time above 200 minutes) had increased postprandial fullness (P = 0.012), abdominal pain (P = 0.026), bloating (P = 0.044), early satiety (P = 0.018), symptomatic composite score (P = 0.005), and a lower quality of life (P = 0.018). This association was no longer observed if the calculation of gastric emptying was limited to the first 4-hour samples. Conclusions There is no association between symptoms, quality of life and gastric emptying in an overall dyspeptic population. However, there is an association between symptoms, quality of life of delayed gastric emptying in the subgroup of patients with severely delayed gastric emptying. An 8-hour measurement of gastric emptying should be recommended.
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Affiliation(s)
- Fabien Wuestenberghs
- Department of Gastroenterology and Hepatology, CHU UCL Namur, Godinne University Hospital, UCLouvain, Yvoir, Belgium.,Department of Physiology, Rouen University Hospital, Normandie University, Rouen, France.,Nutrition, Gut and Brain Laboratory (INSERM UMR 1073), Institute for Biomedical Research and innovation, Rouen University, Normandie University, Rouen, France
| | - Mathilde Juge
- Department of Gastroenterology, Rouen University Hospital, Normandie University, Rouen, France
| | - Chloé Melchior
- Nutrition, Gut and Brain Laboratory (INSERM UMR 1073), Institute for Biomedical Research and innovation, Rouen University, Normandie University, Rouen, France.,Department of Gastroenterology, Rouen University Hospital, Normandie University, Rouen, France
| | - Charlotte Desprez
- Department of Physiology, Rouen University Hospital, Normandie University, Rouen, France
| | - Anne-Marie Leroi
- Department of Physiology, INSERM CIC-CRB 1404, Rouen University Hospital, INSERM Unit 1073, UNIROUEN, Normandie University, Rouen France
| | - Guillaume Gourcerol
- Department of Physiology, Rouen University Hospital, Normandie University, Rouen, France.,Nutrition, Gut and Brain Laboratory (INSERM UMR 1073), Institute for Biomedical Research and innovation, Rouen University, Normandie University, Rouen, France
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Abstract
OBJECTIVES The purpose of this study was to establish normal gastric-emptying values for EnsurePlus in healthy subjects and to determine whether it is an acceptable alternative to the recommended standardized Tc-sulfur colloid egg meal. METHODS Twenty-one healthy subjects underwent gastric-emptying scintigraphy with In-DTPA EnsurePlus. Normal gastric emptying values were established for 1, 2, 3, and 4 hours after meal ingestion. The gastric-emptying results were compared with another group of normal subjects (n = 18) who ingested the standardized egg meal. RESULTS The mean (95% upper reference limit) percentages for gastric retention for EnsurePlus were as follows: 69.9% (87.1%) at 1 hour, 35.1% (64.3%) at 2 hours, 13.5% (23.2%) at 3, and 8.9% (13.5%) at 4 hours. There were time-related differences in the gastric emptying of the EnsurePlus compared with the egg meal. In the first and second hours, there were no difference between EnsurePlus and the egg meal in terms of percentage retention (P = 0.92 at 1 hour, P = 0.05 at 2 hours). However, at 3 and 4 hours after meal ingestion, the mean percentage gastric retention of the EnsurePlus was significantly higher than the egg meal (P < 0.001). CONCLUSION EnsurePlus is a good and acceptable alternative to the standardized egg meal.
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Edwards ST, Cocjin J, Theut SB, Rivard D, Sherman AK, Friesen CA. A comparison of the diagnosis of gastroparesis in 4 h pediatric gastric emptying studies versus 2 h studies. BMC Gastroenterol 2019; 19:26. [PMID: 30744574 PMCID: PMC6371451 DOI: 10.1186/s12876-019-0948-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 01/31/2019] [Indexed: 01/24/2023] Open
Abstract
Background In adults, there is a consensus for standards to diagnose gastroparesis utilizing a gastric emptying study as the key diagnostic modality but there is no consensus for a standard in pediatrics. Additionally, some cost savings might be achieved if symptoms could be utilized to predict patients with gastroparesis. The aims of the current study were to confirm the sensitivity of a 4 h study in the pediatric population and to assess whether the severity of symptoms were predictive of delayed gastric emptying. Study This was a single site, two part study. In the first part, results were reviewed for all patients who had completed a 4-h, solid gastric emptying study over the course of a 3 year period. In the second portion of the study, participants scheduled for a gastric emptying study, completed a modified GCSI questionnaire. Results Out of a total of 109 participants, at 2 h, 14 participants (12.8%) had abnormal studies as compared to 26 (23.85%) participants who had abnormal studies at 4 h (p = .0027). Of the 95 participants with normal studies at 2 h, 15% (14/95) were abnormal at 4 h. There were no differences in symptom severity scores between those with slow and those with normal emptying at either 2 h or 4 h. Conclusions Our study adds independent confirmation that extending studies from 2 to 4 h increases the diagnostic yield and should be the standard in children and adolescents as it is in adults. Electronic supplementary material The online version of this article (10.1186/s12876-019-0948-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Turnipseed Edwards
- Division of Gastroenterolgy, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA. .,Department of Pediatric Gastroenterology, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA.
| | - Jose Cocjin
- Division of Gastroenterolgy, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA
| | | | - Douglas Rivard
- Department of Radiology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Ashley K Sherman
- Health Services and Outcomes Research Division, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Craig A Friesen
- Division of Gastroenterolgy, Children's Mercy Kansas City, 2401 Gillham Rd, Kansas City, MO, 64108, USA
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Hirsch W, Nee J, Ballou S, Petersen T, Friedlander D, Lee HN, Cheng V, Lembo A. Emergency Department Burden of Gastroparesis in the United States, 2006 to 2013. J Clin Gastroenterol 2019; 53:109-113. [PMID: 29256990 PMCID: PMC6005709 DOI: 10.1097/mcg.0000000000000972] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND AND AIMS Gastroparesis, a chronic gastrointestinal disorder defined by delayed stomach emptying in the absence of obstruction, is often associated with frequent and costly visits to the emergency department (ED). The aim of this study was to analyze trends in gastroparesis-related ED visits from 2006 to 2013. MATERIALS AND METHODS Patients with a primary diagnosis of gastroparesis were identified from the Nationwide Emergency Department Sample (NEDS), the largest publicly available ED all-payer representative database in the United States. ED visits, admission rates, duration of hospitalizations, and charges were compiled. Patients with a secondary diagnosis of diabetes mellitus were analyzed as a subgroup. RESULTS The number of ED visits for gastroparesis as a primary diagnosis in the United States increased from 15,459 in 2006 to 36,820 in 2013, an increase from 12.9 to 27.3 per 100,000 ED visits. The total charges associated with these ED visits and subsequent admissions increased from $286 million to $592 million. In contrast, admission rates through the ED decreased by 22%, procedure rates decreased by 6.2%, and the mean length of stay was shortened by 0.6 days. ED visits for patients with diabetic gastroparesis increased from 5696 to 14,114, an increase from 4.7 to 10.5 per 100,000 ED visits, with an increase in total associated charges for ED visits and subsequent admissions from $84 million to $182 million. CONCLUSIONS The number of ED visits and associated charges for a primary diagnosis of gastroparesis with or without a secondary diagnosis of diabetes mellitus rose significantly from 2006 to 2013.
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Affiliation(s)
- William Hirsch
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Judy Nee
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Ballou
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Travis Petersen
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Friedlander
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Ha-Neul Lee
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Vivian Cheng
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
| | - Anthony Lembo
- Division of Gastroenterology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA
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Yoshii N, Sato K, Ogasawara R, Nishimura Y, Shinohara Y, Fujita S. Effect of Mixed Meal and Leucine Intake on Plasma Amino Acid Concentrations in Young Men. Nutrients 2018; 10:nu10101543. [PMID: 30340425 PMCID: PMC6213454 DOI: 10.3390/nu10101543] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 09/19/2018] [Accepted: 10/12/2018] [Indexed: 01/01/2023] Open
Abstract
Dietary protein intake is critical for the maintenance of skeletal muscle mass. Plasma amino acid concentrations increase with protein intake and increases in muscle protein synthesis are dependent on leucine concentrations. We aimed to investigate the effect of a mixed meal and free amino acids intake on plasma leucine concentrations. In this randomized crossover study, 10 healthy young men (age 25 ± 1 years, height 1.73 ± 0.02 m, weight 65.8 ± 1.5 kg) underwent tests under different conditions—intake of 2 g of leucine (LEU), intake of a mixed meal (protein 27.5 g, including 2.15 g of leucine, protein: fat: carbohydrate ratio—22:25:53) only (MEAL), intake of 2 g of leucine immediately after a mixed meal (MEAL-LEU) and intake of 2 g of leucine 180 min after a mixed meal (MEAL-LEU180). Blood samples were collected within 420 min (240 min for LEU only) after intake and changes in amino acid concentrations were evaluated. Although the maximum plasma leucine concentration increased to 442 ± 24 µM for LEU, it was lower at 347 ± 16 µM (p < 0.05 vs. LEU) for MEAL-LEU, 205 ± 8 µM (p < 0.05 vs. LEU) for MEAL. The maximum plasma leucine concentration for MEAL-LEU180 increased to 481 ± 27 µM and compared to LEU there was no significant difference (p > 0.1). The observation that rapid elevations in plasma leucine concentrations are suppressed when leucine is ingested at the same time as a meal suggests that the timing of its intake must be considered to maximize the anabolic response.
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Affiliation(s)
- Naomi Yoshii
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
| | - Koji Sato
- Graduate School of Human Development and Environment, Kobe University, Kobe, Hyogo 657-8501, Japan.
| | - Riki Ogasawara
- Department of Life Science and Applied Chemistry, Nagoya Institute of Technology, Nagoya 466-8555, Japan.
| | - Yusuke Nishimura
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, West Midlands B15 2TT, UK.
| | - Yasushi Shinohara
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
| | - Satoshi Fujita
- Graduate School of Sport and Health Science, Ritsumeikan University, Kusatsu, Shiga 525-8577, Japan.
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Lacy BE, Parkman HP, Camilleri M. Chronic nausea and vomiting: evaluation and treatment. Am J Gastroenterol 2018; 113:647-659. [PMID: 29545633 DOI: 10.1038/s41395-018-0039-2] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 02/05/2018] [Indexed: 12/11/2022]
Abstract
Nausea is an uneasy feeling in the stomach while vomiting refers to the forceful expulsion of gastric contents. Chronic nausea and vomiting represent a diverse array of disorders defined by 4 weeks or more of symptoms. Chronic nausea and vomiting result from a variety of pathophysiological processes, involving gastrointestinal and non-gastrointestinal causes. The prevalence of chronic nausea and vomiting is unclear, although the epidemiology of specific conditions, such as gastroparesis and cyclic vomiting syndrome, is better understood. The economic impact of chronic nausea and vomiting and effects on quality of life are substantial. The initial diagnostic evaluation involves distinguishing gastrointestinal causes of chronic nausea and vomiting (e.g., gastroparesis, cyclic vomiting syndrome) from non-gastrointestinal causes (e.g., medications, vestibular, and neurologic disorders). After excluding anatomic, mechanical and biochemical causes of chronic nausea and vomiting, gastrointestinal causes can be grouped into two broad categories based on the finding of delayed, or normal, gastric emptying. Non-gastrointestinal disorders can also cause chronic nausea and vomiting. As a validated treatment algorithm for chronic nausea and vomiting does not exist, treatment should be based on a thoughtful discussion of benefits, side effects, and costs. The objective of this monograph is to review the evaluation and treatment of patients with chronic nausea and vomiting, emphasizing common gastrointestinal causes.
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Affiliation(s)
- Brian E Lacy
- Mayo Clinic, Jacksonville, FL, USA. Temple University, Philadelphia, PA, USA. Mayo Clinic, Rochester, MN, USA
| | - Henry P Parkman
- Mayo Clinic, Jacksonville, FL, USA. Temple University, Philadelphia, PA, USA. Mayo Clinic, Rochester, MN, USA
| | - Michael Camilleri
- Mayo Clinic, Jacksonville, FL, USA. Temple University, Philadelphia, PA, USA. Mayo Clinic, Rochester, MN, USA
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Abstract
BACKGROUND AND AIMS Gastroparesis (GP) patients suffer from recurrent symptoms of nausea, vomiting, early satiety, and abdominal pain. The impact of GP on quality of life (QoL), health care utilization and daily activities is not well understood. MATERIALS AND METHODS Part 1: 398 adult patients (≥18 y) with documented GP (symptoms >6 mo) were surveyed to assess QoL and pain using the Short Form 36 and McGill pain questionnaires. Part 2: 491 adult GP patients were surveyed to evaluate employment status, work and daily activities, medication use, physician visits, diagnostic testing, emergency room visits, and hospitalizations related to their GP symptoms. Both protocols received Institutional Review Board approval. RESULTS Part 1: 250 fully evaluable surveys were returned (63%). The mean age was 46.8 years (range, 18 to 84 y); 78% were women. Mean Short Form 36 scores for mental health (56.9) and social functioning (68.1) were analogous to scores for patients with serious chronic medical disorders and depression. Pain scores were lower in patients with idiopathic GP compared with diabetic GP. Part 2: 228 evaluable surveys were analyzed (58.3% response rate). The mean age was 49.6 (19 to 86 y); 77.2% were women. GP symptoms reduced daily activities in 67.5% and lowered annual income in 28.5%. In total, 11% were disabled due to GP symptoms. CONCLUSIONS GP reduces patients' QoL and places a significant financial burden on the health care system. Treatment strategies for GP patients should be broad based and incorporate pain management, psychological evaluation and management, and strategies to improve overall well-being with a return to work and daily activities.
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Asano H, Tomita T, Nakamura K, Yamasaki T, Okugawa T, Kondo T, Kono T, Tozawa K, Ohda Y, Oshima T, Fukui H, Fukushima K, Hirota S, Watari J, Miwa H. Prevalence of Gastric Motility Disorders in Patients with Functional Dyspepsia. J Neurogastroenterol Motil 2017; 23:392-399. [PMID: 28423481 PMCID: PMC5503289 DOI: 10.5056/jnm16173] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/14/2017] [Accepted: 02/08/2017] [Indexed: 12/15/2022] Open
Abstract
Background/Aims Gastric motility abnormalities have been considered to be pathophysiological features of functional dyspepsia (FD) that are closely related to dyspepsia symptoms, especially postprandial distress syndrome (PDS). The aims of this study are to (1) investigate the prevalence of gastric motility disorders and (2) evaluate the association between gastric motility abnormalities and dyspeptic symptoms using gastric scintigraphy in the PDS type of FD. Methods Forty healthy subjects and 94 PDS type FD patients were enrolled in the study. The volunteers and patients ingested a radiolabeled (technetium-99m) solid test meal, and scintigraphic images were recorded. Gastric accommodation and emptying were assessed by scintigraphic imaging. The patients’ dyspeptic symptoms were also explored using self-completed symptom questionnaires with 10 variables (4 scales, 0–3 points) at the same time. Results In 94 Japanese FD patients, the prevalence of impaired gastric accommodation and delayed emptying were 14.9% (14/94) and 10.6% (10/94), respectively. Gastric motility abnormalities were seen in 25.5% (24/94) of FD patients. There was no association between gastric motility abnormalities and dyspeptic symptoms. Conclusions Gastric motility abnormalities were seen in 25.5% of Japanese PDS type FD patients. However, there was no association between gastric motility abnormalities and dyspeptic symptoms on gastric scintigraphy.
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Affiliation(s)
- Haruki Asano
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Toshihiko Tomita
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kumiko Nakamura
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takahisa Yamasaki
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takuya Okugawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Takashi Kondo
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tomoaki Kono
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Katsuyuki Tozawa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Yoshio Ohda
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Tadayuki Oshima
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hirokazu Fukui
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Kazuhito Fukushima
- Division of Nuclear Medicine and PET Center, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Shozo Hirota
- Department of Radiology, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Jiro Watari
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
| | - Hiroto Miwa
- Division of Gastroenterology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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Wadhwa V, Mehta D, Jobanputra Y, Lopez R, Thota PN, Sanaka MR. Healthcare utilization and costs associated with gastroparesis. World J Gastroenterol 2017; 23:4428-4436. [PMID: 28706426 PMCID: PMC5487507 DOI: 10.3748/wjg.v23.i24.4428] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/23/2017] [Accepted: 06/01/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To use a national database of United States hospitals to evaluate the incidence and costs of hospital admissions associated with gastroparesis.
METHODS We analyzed the National Inpatient Sample Database (NIS) for all patients in whom gastroparesis (ICD-9 code: 536.3) was the principal discharge diagnosis during the period, 1997-2013. The NIS is the largest publicly available all-payer inpatient care database in the United States. It contains data from approximately eight million hospital stays each year. The statistical significance of the difference in the number of hospital discharges, length of stay and hospital costs over the study period was determined by regression analysis.
RESULTS In 1997, there were 3978 admissions with a principal discharge diagnosis of gastroparesis as compared to 16460 in 2013 (P < 0.01). The mean length of stay for gastroparesis decreased by 20 % between 1997 and 2013 from 6.4 d to 5.1 d (P < 0.001). However, during this period the mean hospital charges increased significantly by 159 % from $13350 (after inflation adjustment) per patient in 1997 to $34585 per patient in 2013 (P < 0.001). The aggregate charges (i.e., “national bill”) for gastroparesis increased exponentially by 1026 % from $50456642 ± 4662620 in 1997 to $568417666 ± 22374060 in 2013 (P < 0.001). The percentage of national bill for gastroparesis discharges (national bill for gastroparesis/total national bill) has also increased over the last 16 years (0.0013% in 1997 vs 0.004% in 2013). During the study period, women had a higher frequency of gastroparesis discharges when compared to men (1.39/10000 vs 0.9/10000 in 1997 and 5.8/10000 vs 3/10000 in 2013). There was a 6-fold increase in the discharge diagnosis of gastroparesis amongst type 1 DM and 3.7-fold increase amongst type 2 DM patients over the study period (P < 0.001).
CONCLUSION The number of inpatient admissions for gastroparesis and associated costs have increased significantly over the last 16 years. Inpatient costs associated with gastroparesis contribute significantly to the national healthcare bill. Further research on cost-effective evaluation and management of gastroparesis is required.
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Hasler WL, Li B, Koch KL, Parkman HP, Kovacic K, McCallum RW. Methodologic considerations for studies of chronic nausea and vomiting in adults and children. Auton Neurosci 2017; 202:28-39. [DOI: 10.1016/j.autneu.2016.08.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2016] [Revised: 07/31/2016] [Accepted: 08/01/2016] [Indexed: 12/12/2022]
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Ziessman HA. Gastrointestinal Transit Assessment: Role of Scintigraphy: Where Are We Now? Where Are We Going? ACTA ACUST UNITED AC 2016; 14:452-460. [DOI: 10.1007/s11938-016-0108-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Treating an oft-unrecognized and troublesome entity: using gastric electrical stimulation to reduce symptoms of malignancy-associated gastroparesis. Support Care Cancer 2016; 25:27-31. [DOI: 10.1007/s00520-016-3375-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Accepted: 08/08/2016] [Indexed: 12/11/2022]
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Abstract
Ingestion and digestion of food as well as expulsion of residual material from our gastrointestinal tract requires normal propulsive, i.e. motor, function. Hypomotility refers to inherited or acquired changes that come with decreased contractile forces or slower transit. It not only often causes symptoms but also may compromise nutritional status or lead to other complications. While severe forms, such as pseudo-obstruction or ileus, may have a tremendous functional impact, the less severe forms of hypomotility may well be more relevant, as they contribute to common disorders, such as functional dyspepsia, gastroparesis, chronic constipation, and irritable bowel syndrome (IBS). Clinical testing can identify changes in contractile activity, defined by lower amplitudes or abnormal patterns, and the related effects on transit. However, such biomarkers show a limited correlation with overall symptom severity as experienced by patients. Similarly, targeting hypomotility with pharmacological interventions often alters gut motor function but does not consistently improve symptoms. Novel diagnostic approaches may change this apparent paradox and enable us to obtain more comprehensive information by integrating data on electrical activity, mechanical forces, patterns, wall stiffness, and motions with information of the flow of luminal contents. New drugs with more selective effects or more specific delivery may improve benefits and limit adverse effects. Lastly, the complex regulation of gastrointestinal motility involves the brain-gut axis as a reciprocal pathway for afferent and efferent signaling. Considering the role of visceral input in emotion and the effects of emotion on visceral activity, understanding and managing hypomotility disorders requires an integrative approach based on the mind-body continuum or biopsychosocial model of diseases.
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Affiliation(s)
- Klaus Bielefeldt
- Department of Internal Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Ashok Tuteja
- Department of Medicine, University of Utah, Salt Lake City, UT, USA
| | - Salman Nusrat
- Department of Medicine, Oklahoma University Medical Center, Oklahoma City, OK, USA
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Wellington J, Scott B, Kundu S, Stuart P, Koch KL. Effect of endoscopic pyloric therapies for patients with nausea and vomiting and functional obstructive gastroparesis. Auton Neurosci 2016; 202:56-61. [PMID: 27460691 DOI: 10.1016/j.autneu.2016.07.004] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 07/14/2016] [Accepted: 07/15/2016] [Indexed: 01/08/2023]
Abstract
Gastroparesis (GP) is associated with loss of interstitial cells of Cajal (ICCs) and gastric dysrhythmias such as tachygastria. We hypothesized that a subset of patients with GP, normal 3cycles per minute (cpm) gastric myoelectrical activity (GMA), and normal upper endoscopy may respond to pyloric therapies. AIMS To determine the effect of botulinum toxin A (btA) injection or balloon dilation (BD) of the pylorus on symptoms and body weight in patients with GP and 3cpm GMA. METHODS Patients were identified who had GP, normal 3cpm GMA, and normal endoscopy that excluded mechanical obstruction of the pylorus. Electrogastrograms (EGG) with water load tests (WLT) were recorded to determine GMA. Gastric emptying was measured with 4h scintigraphy. Each patient underwent up to three pyloric treatments with btA or BD. RESULTS Thirty-three patients (29 women) with an average age of 42years were studied. Seventy-nine percent had idiopathic GP and 21% had diabetic GP. The average percent meal retained at 4h was 42% and each EGG test showed normal 3cpm GMA. Nausea was the major symptom in 76% of patients. Complete or partial symptom response occurred in 75%, 72%, and 88% of patients after the first, second, or third endoscopic pyloric treatment, respectively. Overall, 78% of the 33 patients reported improvement in symptoms and average weight gain was 1.54lb from baseline to final treatment (p<0.04). CONCLUSION Pyloric therapies appear to be effective treatments in symptomatic patients with GP and 3cpm GMA and controlled trials are warranted.
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Affiliation(s)
- Jennifer Wellington
- Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States.
| | - Blake Scott
- Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Sarba Kundu
- Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Paula Stuart
- Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
| | - Kenneth L Koch
- Section on Gastroenterology, Wake Forest School of Medicine, Winston-Salem, NC 27157, United States
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Samuel B, Atiemo K, Cohen P, Czerniach D, Kelly J, Perugini R. The Effect of Sleeve Gastrectomy on Gastroparesis: A Short Clinical Review. Bariatr Surg Pract Patient Care 2016. [DOI: 10.1089/bari.2015.0052] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Bankole Samuel
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Kofi Atiemo
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Phillip Cohen
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Donald Czerniach
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - John Kelly
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
| | - Richard Perugini
- Department of Surgery, University of Massachusetts, Worcester, Massachusetts
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Kalkan Ç, Soydal Ç, Özkan E, Maden A, Soykan I. Relationships between autonomic nerve function and gastric emptying in patients with autoimmune gastritis. Clin Auton Res 2016; 26:189-96. [PMID: 27059861 DOI: 10.1007/s10286-016-0353-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Accepted: 03/06/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE Autonomic nervous system dysfunction exists in autoimmune diseases. Symptoms of autoimmune gastritis are not specific, and some patients may present symptoms suggestive of delayed gastric emptying. This study aims to investigate whether any autonomic dysfunction exists in autoimmune gastritis patients, and if so, to clarify the relationship between the autonomic nervous dysfunction, delayed gastric emptying, and gastrointestinal symptoms. METHODS 75 patients (50 women, mean age 56.73 ± 11.77) diagnosed with autoimmune gastritis were investigated by means of autonomic nervous system and gastric emptying tests. All patients underwent a standardized scintigraphic gastric emptying study and five tests evaluating autonomic nervous system. Patients with autonomic nervous system dysfunction were then analyzed and compared by means of existence of delayed gastric emptying and gastrointestinal symptoms. RESULTS 62 patients had autonomic nervous system dysfunction (14 mild, 40 moderate, and 8 severe autonomic dysfunction). The mean total score of autonomic tests was 3.85 ± 2.35. Total autonomic score of patients (n = 60) with delayed gastric emptying was significantly higher than patients (n = 15) with normal gastric emptying (4.68 ± 1.7 vs. 1.53 ± 0.58, p < 0.001). Mean gastroparesis cardinal symptom index was significantly higher in patients (n = 60) with delayed gastric emptying half-time compared to patients (n = 15) with normal gastric emptying half-time (1.89 ± 1.16 vs 0.4 ± 0.3, p < 0.001). CONCLUSIONS Most of patients with autoimmune gastritis also have autonomic nerve dysfunction. There is a close relationship between autonomic nervous system dysfunction and delayed gastric emptying. Gastroparesis cardinal symptom index has a high sensitivity and specificity in predicting both autonomic nerve function and delay in gastric emptying.
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Affiliation(s)
- Çağdaş Kalkan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Çiğdem Soydal
- Department of Nuclear Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Elgin Özkan
- Department of Nuclear Medicine, Ankara University Faculty of Medicine, Ankara, Turkey
| | - Ata Maden
- Department of Gastroenterology, Ankara University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey
| | - Irfan Soykan
- Department of Gastroenterology, Ankara University Faculty of Medicine, Sihhiye, 06100, Ankara, Turkey.
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Maurer AH. Gastrointestinal Motility, Part 1: Esophageal Transit and Gastric Emptying. J Nucl Med Technol 2016; 44:1-11. [DOI: 10.2967/jnumed.112.114314] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 05/15/2015] [Indexed: 12/19/2022] Open
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DiBaise JK, Patel N, Noelting J, Dueck AC, Roarke M, Crowell MD. The relationship among gastroparetic symptoms, quality of life, and gastric emptying in patients referred for gastric emptying testing. Neurogastroenterol Motil 2016; 28:234-42. [PMID: 26547484 DOI: 10.1111/nmo.12718] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 10/06/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Symptoms suggestive of gastroparesis are non-specific and conflicting reports exist regarding the ability of symptoms to predict the presence of gastroparesis. Our aim, therefore, was to evaluate the relationships between gastroparetic symptoms and their impact on quality of life and determine their relationship with clinical factors and gastric emptying. METHODS Gastric emptying scintigraphy, sociodemographic features, health care resource utilization, gastroparetic symptoms, and quality of life using validated questionnaires were obtained from consecutive patients referred for gastric emptying testing (GET). Descriptive analyses were conducted and logistic regression was performed to evaluate associations with abnormal gastric emptying after controlling for other covariates. KEY RESULTS Two hundred and sixty-six patients participated (195 females; mean age, 49.1 ± 17.6 years); 75% met Rome III criteria for functional dyspepsia. Gastric emptying was delayed in 28.2% at 4 h; the delay was mild in 48%, moderate in 20% and severe in 32%. Nausea/emesis and postprandial fullness, but not bloating, were significantly greater in those with delayed emptying. Postprandial fullness was most severe. Weak correlations were identified between symptom severity and the severity of gastric emptying delay. Quality of life was also lower in the delayed emptying group. Logistic regression analysis demonstrated associations between delayed gastric emptying and lower quality of life and increased symptom severity. CONCLUSIONS & INFERENCES In patients referred for GET, gastroparetic symptoms were more severe in those with delayed emptying. A decrease in quality of life in those with delayed gastric emptying was also present; this was not related to the severity of the delay in gastric emptying.
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Affiliation(s)
- J K DiBaise
- Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA
| | - N Patel
- Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA
| | - J Noelting
- Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA
| | - A C Dueck
- Department of Biostatistics, Mayo Clinic, Scottsdale, AZ, USA
| | - M Roarke
- Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA
| | - M D Crowell
- Department of Gastroenterology, Mayo Clinic, Scottsdale, AZ, USA
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Abstract
OPINION STATEMENT Gastroparesis (GP) is a syndrome characterized by delayed gastric emptying in association with symptoms of epigastric pain, nausea, and vomiting in the absence of mechanical obstruction. The prevalence of gastroparesis has been estimated at 24 per 100,000, with women more commonly affected than men. Diabetes appears to be the underlying cause in approximately 25 % of patients, while connective tissue disorders, autoimmune disorders, prior gastric surgery, ischemia, and medications make up a smaller percentage of the remaining identifiable causes. However, the largest group of GP patients falls into the idiopathic category (~50 %); many of these patients likely develop GP as a result of a prior viral infection. Symptoms of gastroparesis develop due to a number of different pathophysiologic processes, including disorders of fundic accommodation, antroduodenal dyscoordination, a weak antral pump, gastric dysrhythmias, abnormal duodenal feedback, and enhanced visceral sensation. Once the diagnosis of GP is made, the clinician has a number of different treatment options. For patients with mild to moderate symptoms, dietary modifications in conjunction with or without prokinetics and antiemetics are often all that is required. However, many patients with severe symptoms who fail to respond to standard therapy may benefit from neuroenteric stimulation (gastric electrical stimulation). This monograph will review the role of the neuroenteric stimulator therapy for gastroparesis, discuss possible mechanisms of action of neuroenteric stimulation, review data from recently published studies on its efficacy, and discuss patient selection and adverse events.
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Affiliation(s)
- Brian E Lacy
- Division of Gastroenterology & Hepatology, Dartmouth-Hitchcock Medical Center, 1 Medical Center Drive, Lebanon, NH, 03756, USA.
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Low CS, Ahmed H, Notghi A. Pitfalls and Limitations of Radionuclide Hepatobiliary and Gastrointestinal System Imaging. Semin Nucl Med 2015; 45:513-29. [DOI: 10.1053/j.semnuclmed.2015.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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