Emptying Time In Patients Research Articles

Evaluation of Gastric Emptying Time in Patients with Subclinical Hypothyroidism and Euthyroid Goiter

Evaluation of Gastric Emptying Time in Patients with Subclinical Hypothyroidism and Euthyroid Goiter

Comparison of gastric emptying before and after treatment for subclinical hypothyroidism

Aim: The aim of this study was to evaluate the effect of levothyroxine treatment on dyspeptic symptoms and gastric emptying time in patients with subclinical hypothyroidism. Materials and Methods: Liquid gastric emptying scintigraphy was performed to detect the presence of gastroparesis in patients with dyspeptic complaints who were followed up with a diagnosis of subclinical hypothyroidism in the thyroid outpatient clinic. Those with specific hypothyroidism symptoms during their follow-up were treated with low dose (25 mg) levothyroxine for at least 6 months. Liquid gastric emptying scintigraphy test was performed again after treatment for those who continued to have dyspeptic complaints. Patients whose gastric emptying time was calculated using a liquid gastric emptying scintigraphy test before and after levothyroxine treatment were retrospectively examined. For testing, 18.5-37 MBq (0.5-1 mCi) 99m-TC nanocolloid was added to 300 ml of water. Late images were acquired at 30 minutes and one hour. The time activity curve was obtained. Results: Gastric emptying was normal in 13 (23.6%) patients in the liquid gastric emptying scintigraphy test performed before treatment. After treatment, gastric emptying half-time was normalized in 34 (81%) of 42 (76.4%) patients with a long gastric emptying half-time before treatment. In total, 47 patients had normal gastric emptying half-time values after treatment, and gastric emptying half-time was calculated to be long in 8 patients (14.5%). Conclusion: In our study, gastric emptying time was prolonged in 76.4% of patients with subclinical hypothyroidism, and in 81% of these patients, gastric emptying time was calculated within normal limits after LT4 treatment. Detection of prolongation of gastric emptying time due to the presence of gastroparesis in subclinical hypothyroidism cases followed up without treatment may be a guide in the prescription of treatment.

Dietary Interventions for Gastroparesis: A Systematic Review

Gastroparesis (Gp) is a delay in gastric emptying in the absence of a mechanical obstruction and has the capacity to cause symptoms that significantly impact a patient's quality of life. Dietary interventions are the first-line treatment in Gp, but the efficacy of different diets is unclear. This systematic review seeks to determine the effectiveness of dietary interventions on clinical outcomes in Gp. A literature search of MEDLINE Ovid from 1 March 2008 to 1 October 2021 was conducted to identify randomized controlled trials, cohort studies, and cross-sectional studies that reported dietary interventions in Gp. From the initial search, 2789 studies resulted. These were assessed by 2 independent reviewers and selected based on the primary outcomes of interest: changes in symptom-specific patient-reported outcomes and changes in gastric emptying time. A third reviewer resolved any discrepancies. Six adult studies (185 subjects) met the inclusion criteria, whereas no pediatric study did. Five of the included studies were randomized controlled trials and one was an observational study. The systematic review suggested low-fat diets, small-particle diets, diets with isoflavones, and foods considered bland, starchy, sweet, and salty did not exacerbate Gp symptoms. Small-particle diets and diets with isoflavones were found to improve gastric emptying time in patients. Additionally, small-particle diets were shown to reduce anxiety in comparison to large-particle diets. Of the randomized controlled trials, 80% were low risk of bias and 20% were fair risk of bias. The observational study was considered fair quality. The data presented in this review suggest specific dietary interventions could potentially improve Gp symptoms and gastric emptying in adult patients, particularly low-fat and small-particle diets. For pediatric Gp, data are lacking. The limited data available highlights a critical gap in the literature.

Relation between clinical features and gastric emptying time in diabetic patients.

Gastroparesis is characterized by delayed gastric emptying. This pathology is usually observed in patients with diabetes. One standard approach to quantitative assessment of gastric emptying is scintigraphic study. The aim of present study was to perform scintigraphic study of gastric emptying time in patient with diabetes and to find its correlation with patients' characteristics. Gastric emptying was assessed in 19 patients with type 2 diabetes (mean age of 61.04 ± 6.09 years) and 6 healthy volunteers. Characteristics of the patients were sex, age, duration of diabetes, blood sugar and serum HbA1c level. Results of present study revealed that gastric emptying half time was significantly larger in patients with type 2 diabetes as compared with healthy volunteers (P-value < 0.05). While correlation of sex, age, duration of diabetes and blood sugar with gastric emptying time was not statistically significant, HbA1c level had significant effect on gastric emptying time. Results of this prospective study indicated that level of serum HbA1c is an effecting factor on gastric emptying time in patients with type 2 diabetes; however, these preliminary findings should be validated in larger and well-designed studies.

Peroral Gastric Placement of Wireless Motility Capsule (WMC; Smartpill®) Under Fluoroscopy: A Novel Method for Patients with Inability to Swallow

Purpose: Wireless motility capsule (WMC; Smartpill®) is a cylindrical 2.8-cm-long and 11.7-mm-wide ingestible capsule used to evaluate regional and whole gut transit and motility. It is approved for evaluation of gastric emptying time in patients suspected with gastroparasis and colonic/whole gut transit in constipation or generalized dysmotility. Occasionally patients experience difficulty with swallowing WMC despite no esophageal obstruction. We report a novel approach of capsule placement in patients who experience difficulty with swallowing capsule. Methods: Over 1 year, three patients requiring WMC test failed to swallow capsule despite multiple attempts over more than a 1-hour period. All subjects came to motility lab after an overnight fast, swallowed a 260 kcal Smartbar and 100 mL water. All subjects had normal EGD previously excluding luminal obstruction. They either retained capsule in mouth or spit it back. For patient demographics see Table 1. To facilitate placement, the WMC was grasped by PillCam capsule placing device (Given). After applying oropharyngeal anesthesia with lidocaine, the device with capsule was advanced through the oropharynx into stomach. Under fluoroscopy we confirmed the location of the device tip in stomach. The capsule was released and the device was removed.TableResults: All three subjects had a successful study. The results of WMC are shown in Table 1. We combined orogastric placement with fluoroscopy to ensure that capsule is released in stomach and not in esophagus. One patient had prolonged retention of capsule for longer than 5 days and had a planned endoscopy 4 days later for evaluation of gastroparesis, and retained capsule was removed. All patients benefited from WMC study. No other adverse event was encountered (Table 1). Conclusion: Peroral gastric placement of WMC using capsule placement device and fluoroscopy is feasible, and may serve as a useful method of delivering capsule into the stomach in patients encountering problems with ingestion of WMC. This method may allow performance of the transit/motility study and provide important pathophysiologic information in patients who encounter difficulty with swallowing capsule. Disclosure - Dr. Satish Rao - Consultant: SmartPill Corporation, has received unrestricted and/or reseach grants

Oxytocin prolongs the gastric emptying time in patients with diabetes mellitus and gastroparesis, but does not affect satiety or volume intake in patients with functional dyspepsia

BackgroundOxytocin is released in response to a fatty meal. Blockage of the oxytocin receptor led to slower gastric emptying whereas stimulation resulted in less satiety in healthy volunteers. Patients with diabetes mellitus and gastroparesis lack oxytocin elevation, and dyspepsia is partly caused by reduced fundus accommodation causing early satiety and related symptoms. The aim of this study was thus to examine the effect of oxytocin on gastric emptying, satiety and volume intake in patients with gastrointestinal pathology.ResultsGastric emptying scintigraphy was performed twice in 12 patients with diabetic gastroparesis, once with oxytocin and once with saline as intravenous infusions. The patients scored their sensation of satiety using a visual analogue scale (VAS). The gastric emptying in patients with gastroparesis was prolonged during oxytocin infusion (p = 0.034) without affecting satiety. A slow satiety drinking test was performed in 14 patients with functional dyspepsia. The patients scored their satiety every five minutes until maximal satiety was reached, and the total volume was determined. The VAS was also completed 30 minutes afterwards. The test was performed twice, once with oxytocin and once with saline as intravenous infusions. There was no difference in satiety scores or volume of nutrient intake between saline and oxytocin infusions, either before, during or after the meal.ConclusionsOxytocin prolongs gastric emptying in patients with diabetes mellitus and gastroparesis, but has no effect on volume of nutrient intake or satiety and other related symptoms in patients with functional dyspepsia.

Evaluation of regional and whole gut motility using the wireless motility capsule: relevance in clinical practice

The wireless motility capsule (WMC) is an ambulatory noninvasive and nonradioactive diagnostic sensor that continuously samples intraluminal pH, temperature, and pressure as it moves through the gastrointestinal (GI) tract. This review summarizes the data obtained in clinical trials with the WMC and discusses its role in clinical practice. The United States Food and Drug Administration has approved the SmartPill GI monitoring system for the evaluation of gastric emptying time in patients with suspected gastroparesis, the evaluation of colonic transit time in patients with suspected chronic constipation, and for the characterization of pressure profiles from the antrum and duodenum. Clinical studies have shown that WMC-measured GI transit times can distinguish patients with motility abnormalities similarly to conventional testing. However, the WMC offers the advantage of providing a full GI-tract profile, enabling the detection of multiregional GI transit abnormalities in patients with suspected upper or lower GI dysmotility. The WMC also characterizes pressure profiles of the GI tract and impaired pressure profile limits are reported for the antrum and duodenum. In comparison with manometry, interpretations of pressure measurements obtained by the WMC are limited by an inability to detect a peristaltic pressure wave front, and further investigation is required to develop clinical applications. Clinical studies with the WMC indicated that it should be considered for the evaluation of regional and whole gut transit time in patients with suspected upper or lower dysmotility, particularly if there are concerns about multiregional dysmotility.

Measuring of gastric emptying in Egyptian pediatric patients with portal hypertension by using real-time ultrasound

Background/Aim:Among the various methods for evaluating gastric emptying, the real-time ultrasound is safe, does not require intubation, or rely on either radiologic or radionuclide technique. The aim of our work was to measure the gastric emptying in pediatric patients with portal hypertension by using the real-time ultrasound.Patients and Methods:Forty patients with portal hypertension with mean age 7 ± 2.8 years and 20 healthy children as a control group underwent gastric emptying study by using real-time ultrasound. The cross-sectional area of the gastric antrum was measured in the fasting state and then each subject was allowed to drink tap water then calculated by using formula area (π longitudinal × anteroposterior diameter/4). The intragastric volume was assumed to be directly proportional to the cross-sectional area of the antrum.Results:The mean gastric emptying half-time volume was significantly delayed in portal hypertension patients (40 ± 6.8 min) compared with the control subjects (27.1 ± 3.6) min (P<0.05). Patients with extrahepatic portal vein obstruction had significant delayed gastric emptying in comparison to patients with portal hypertension due to other etiologies (36.14 ± 4.9 vs 44.41 ± 6.04 min; P<0.01).Conclusion:Ultrasound is a noninvasive and a reliable method for measuring gastric emptying in pediatric patients. Gastric emptying was significantly delayed in patients with portal hypertension. Etiology of portal hypertension may influence gastric emptying time in patients with chronic liver disease.

Delayed gastric emptying in patients with caustic ingestion

Patients with caustic ingestion may develop esophageal and/or gastric cicatrization. Scintigraphic assessment of liquid gastric emptying time in patients with caustic ingestion. Consecutive patients with caustic-induced esophageal cicatrization attending the gastroenterology clinic of our institute were studied (patients with age >or=60 years, earlier gastric surgery, vagotomy, peptic ulcer disease, diabetes, systemic sclerosis, and those on gastrointestinal motility-altering drugs were excluded). Gastric emptying time was assessed by radionuclide scintigraphy (ingestion of 200 ml mango juice containing of 18.5 MBq 99mTc sulfur colloid after an overnight fast by static imaging in anterior and posterior projections in supine posture at 10 min intervals each for 1 h). A time-activity curve was generated and gastric half-emptying time (GET 1/2) was calculated. Results were compared with GET 1/2 values estimated for normal individuals in our laboratory (mean+/-2 SD). The emptying study protocol for normal individuals was the same as in patients. Twenty patients (males 10) median age 32 years, 16 with acid ingestion and four with alkali ingestion, were studied. No patient had symptoms suggestive of gastric outlet obstruction or gastroparesis. Eight patients had evidence of gastric cicatrization in the form of straightening of the lesser curvature and pulling of incisura and duodenal bulb medially and loss of parallelism between the fundus and left dome of diaphragm. Gastric distensibility was however normal in them. As compared with values for normal controls (25+/-9 min), GET 1/2 was significantly prolonged in the study group as a whole (53.2+/-27.77 min, P=0.000). No significant difference was observed between different age groups, sex, or type of caustic agent consumed. GET 1/2 differed in patients (n=10) with stricture involving lower-third of esophagus (72.2+/-27.67 min) when compared with those (n=10) who had a stricture involving upper and/or middle-third of esophagus (34.3+/-8.02 min, P=0.000). In the former, GET 1/2 was maximally prolonged in patients (n=6) with involvement of the lower esophagus and reduced stomach capacity (84.6+/-27.03 min), followed by patients (n=4) with lower esophageal involvement with normal stomach capacity (53.7+/-17.41 min), but the difference did not reach statistical significance (P=0.078). Patients (n=10) without lower esophageal involvement did not have statistically significant altered GET 1/2 compared with normal controls (P>0.05). Our results show that patients with caustic ingestion have prolonged liquid gastric emptying even in the absence of any gastric symptoms.

T1330 Correlation Between Plasma Ghrelin Levels and Gastric Emptying Time in Patients with Functional Dyspepsia and Non-Erosive Reflux Diseases

T1330 Correlation Between Plasma Ghrelin Levels and Gastric Emptying Time in Patients with Functional Dyspepsia and Non-Erosive Reflux Diseases

Studies of gastric emptying time in patients with non-ulcer dyspepsia

To assess the gastric emptying pattern of a standardized solid meal in patients with non-ulcer dyspepsia by using scintigraphic techniques. Results for the half-emptying time for solids (T1/2) and percent clearance of solid meal at 60 min (C60) of patients (n=35) having non-ulcer dyspepsia according to Rome II criteria were compared with age- and sex-matched controls (n=28). Gastric emptying was studied by using egg omelette labelled with Tc tin colloid. Data acquisition was done using two protocols: dynamic acquisition was performed for the first 100 min and then static acquisition was carried out for up to 4 h. T1/2 and C60 were calculated from the computer-generated time-activity curve. The normal range of T1/2 was 29-88 min (mean+/-2 SD) among the control group. The mean T1/2 of the patient group was 160.1+/-96.1 min (P<0.01). Twelve of 22 male patients and 11 of 13 female patients had prolonged T1/2. The normal range of C60 was 92-28% (mean+/-2 SD) in the control group. The mean C60 of the patient group was 33.1+/-18.5% (P<0.01). Fifteen of 22 male patients and 11 of 13 female patients had shortened C60. Gastric emptying is significantly delayed in both men and women having non-ulcer dyspepsia as the T1/2 is prolonged and the C60 is shortened in a significant number of these patients. Radionuclide tests might offer an objective way of assessing this particular aspect of gastric physiology.

The impact of B12 treatment on gastric emptying time in patients with Helicobacter pylori infection

The impact of B12 treatment on gastric emptying time in patients with Helicobacter pylori infection

Gastric emptying time and gastric motility in patients with Parkinson's disease.

Gastrointestinal symptoms such as nausea, abdominal pain, and bloating are frequent complaints of patients with Parkinson's disease (PD). It has been postulated that impaired gastrointestinal function may contribute to the development of motor fluctuations such as delay on and no on in patients with PD. Gastrointestinal impaired function and symptoms may be associated with the disease itself or secondary to levodopa treatment. Thus, we assessed gastric emptying (GE) and gastric motility in PD patients to examine the association between clinical status and gastric function. GE and antral contraction (frequency and amplitude) were evaluated by scintigraphy in 29 patients with mild PD (Hoehn and Yahr [H&Y] stage 1.0-2.0); 22 patients with moderate PD (H&Y stage 2.5-3.0); and 22 healthy volunteers, following the ingestion of a labeled standard meal. Gastric emptying (mean +/- SD of T(1/2)) and antral contraction were not significantly different between patients with mild PD (63.4 +/- 28.8 minutes) and moderate PD (54.7 +/- 25.5 minutes). In the control group, GE was 43.4 +/- 10.8 minutes (range 29.0 - 61.0 minutes). The prevalence of delayed emptying (>61 minutes) was not significantly different in patients with mild disease (48.3%) as compared with patients with moderate disease (36.4%). Antral contraction, both frequency and amplitude, were not significantly different between patients with mild and moderate PD throughout the entire 100 minutes of the study. Untreated patients (n = 28) had mean GE T(1/2) of 59 +/- 30.6 minutes. Patients with smooth response to levodopa showed slower GE (n = 10; 73.6 +/- 25.3 minutes), while treated patients with motor response fluctuations when tested at the on state (n = 13), had much faster GE (49.3 +/- 16.2 minutes). This shortened GE in the on state was similar to the GE of normal volunteers. We conclude that gastric emptying time in patients with PD was delayed compared with control volunteers. It was even slower in patients treated with levodopa. This effect of levodopa treatment was reversed to pseudonormalization (normal GE) at the advanced stages of the disease, when patients developed motor response fluctuation. Other clinical features of PD were not associated with delayed gastric emptying.

The relationship between autonomic nerve dysfunction and gastric emptying time in patients with functional dyspepsia

The relationship between autonomic nerve dysfunction and gastric emptying time in patients with functional dyspepsia

The Effect of Dialysate Dwell on Gastric Emptying Time in Patients on Continuous Ambulatory Peritoneal Dialysis

We evaluated gastric emptying time (GET) with a technetium (Tc) 99m-sulfur colloid gastric emptying scan in 11 patients on continuous ambulatory peritoneal dialysis (CAPD) (6 males, 5 females) and in 14 controls. We investigated the effect of dialysate dwell on GET by studying the subjects twice: once without dialysate in the abdomen (drained) and once with 2 L of dialysate in the abdomen (full). We also investigated the relationship between body surface area (BSA) and delayed gastric emptying. (1) The mean gastric emptying rate in 120 minutes in patients on CAPD when drained (67.8%+/-13.4%) was not different from that in controls (65.4%+/-8.6%). (2) The mean gastric emptying rate in 120 minutes in patients on CAPD when full was significantly slower than that when drained (55.6%+/-14.6% versus 67.8%+/-13.4%, p < 0.05). In four of the 11 patients (36.4%), gastric emptying was extremely delayed from normal to abnormal range when full. (3) The BSA of patients who had extremely delayed GET from normal to abnormal range was smaller than that of patients who had minimal delayed or unchanged GET when full (1.5+/-0.11 m2 versus 1.74+/-0.22 m2). This study showed that patients on CAPD had normal gastric emptying when drained, and that gastric emptying was delayed by dialysate dwell, especially in patients who has less than 1.5 m2 of body surface area. Therefore, we suggest that, based on adequacy, intermittent nocturnal peritoneal dialysis or a small volume of dialysate be considered for patients with small body surface area.

Gastric emptying time in patients with primary hypothyroidism.

Symptoms due to slowing of gastrointestinal motility constitute an important problem in most patients with primary hypothyroidism. The purpose of this study was to calculate gastric emptying time in patients with primary hypothyroidism using a radioisotopic method. Fifteen hypothyroid patients (2 male, 13 female) participated in the study. Mean age was 43 (range 38-50) years. Only patients who had been recently diagnosed and had received no previous therapy were included in the study. Radiological and endoscopic examination of the upper gastrointestinal tract was carried out. Patients with gastric outlet obstruction were excluded. Twelve healthy and euthyroid people with no detectable gastrointestinal pathology were examined as a control group. The mean age of this group was 45 (range 35-55) years. Patients and control group received a semisolid meal containing 1 mCi technetium-99m sulphur colloid and measurements were made from the epigastrium. Mean gastric emptying half-time (t(half)) was 112.13+/-48.96 min in hypothyroid patients and 57.87+/-6.38 min in the control group. Gastric emptying time of the hypothyroid patients was significantly different from the control group (P< 0.001). There was no correlation between gastric emptying time and serum thyroid-stimulating hormone (TSH) levels. We concluded that radioisotopic study is a safe, rapid and reliable method for determining gastric emptying time in patients with primary hypothyroidism.

Ultrasound measurement of gastric emptying time in patients with cystic fibrosis and effect of ranitidine on delayed gastric emptying

Intestinal dysmotility is commonly reported in patients with cystic fibrosis (CF); however, gastric motor activity has rarely been investigated. We measured with real-time ultrasonography the antral distention and gastric emptying time of a solid-liquid meal in 29 patients with CF (age range, 5 to 17 years). A significantly prolonged gastric emptying time was present in 26 patients compared with 13 healthy control subjects (age range, 5 to 16 years); an exaggerated antral distention in the fed period was also detected. The patients with CF and delayed gastric emptying were randomly allocated to receive cisapride or ranitidine for 4 weeks. Twelve patients treated with ranitidine and 11 with cisapride completed the trial. There was a marked decrease in gastric emptying time, antral distention, and dyspeptic symptomatic score in patients receiving ranitidine but not in patients treated with cisapride. We conclude that gastric dysmotility is commonly detected in patients with CF and that H 2 receptor blockers are more effective than prokinetics in improving dyspeptic symptoms and gastric emptying and distention. (J P EDIATR 1996;128:485-8)

Pharmacokinetics and pharmacodynamics of cisapride in patients undergoing hemodialysis

Twenty-two patients who were receiving hemodialysis were studied in three groups of eight subjects each to assess the pharmacokinetics during the dialysis-free interval and during hemodialysis treatment and to assess the pharmacodynamics of cisapride. Cisapride and its metabolite norcisapride were measured by use of HPLC and gas chromatography, respectively. The pharmacodynamic effect of cisapride was measured by means of radionuclide gastric emptying. After a single oral dose of 20 mg the terminal half-life of cisapride was 9.6 +/- 3.3 hours, the volume of distribution was 4.8 +/- 3.3 L/kg, the total oral plasma clearance was 380 +/- 161 ml/min, the area under the curve was 1024 +/- 447 ng.hr/ml (mean +/- SD). Norcisapride only could be detected in the dialysate (0.36 +/- 0.067 mg) and was eliminated by a hemodialysis clearance of 34.7 +/- 7.9 ml/min. Cisapride reduced gastric retention from 77.6% +/- 21.1% to 43.7% +/- 18.2% of maximum filling (40 minutes after meals) and normalized the abnormal gastric emptying time in patients receiving dialysis. Cisapride dosage adjustment or substitution after hemodialysis is not necessary.

Dynamic aspects of gastric emptying in patients with peptic ulcer according to ulcer stages.

The pattern and the time of gastric emptying were investigated in 38 patients with peptic ulcer and 7 healthy volunteers using the double-sampling method. The pattern of gastric emptying assumed the following three attitudes, that is, exponential (44%), quadratic (29%) and unclassified (27%) pattern. These patterns appeared to depend on the distance from the gastric angle to the pyloric ring measured from X-ray pictures in the upright position. There was no significant difference in the gastric emptying time in patients with peptic ulcer according to its site. During follow-up observations of the same case, the gastric emptying time had a tendency to shorten in patients with duodenal ulcer while it showed no definite variation in patients with gastric ulcer.