Gastric Emptying Scan Research Articles

Scintigraphic assessment of gastric emptying of canned and dry diets in healthy cats

Abstract Objective To characterize factors that affect solid-phase gastric emptying in healthy cats by use of nuclear scintigraphy and to assess differences in emptying patterns of dry and canned diets. Animals 20 healthy cats. Procedure 2 groups of 10 cats each were fed dry or canned diet for at least 2 weeks before scintigraphy was done. Diets were labeled with 99mTc-disofenin. After ingestion of labeled meals, scintigraphic images were obtained at 0, 15, 30, 45, and 60 minutes, then every 30 minutes to 6 hours. Gastric emptying scans were obtained 3 times for each cat for each diet, in a complete crossover design. The T90, T50, and T20 (times when 90, 50, and 20% of initial meal activity remained in the stomach, respectively) were derived from gastric emptying curves fit to nonlinear models. A mixed models approach was used for data analysis. Results Gastric emptying was well described by a nonlinear model. Meal size, water intake, and diet type significantly (P < 0.05) effected gastric emptying. The T90, T50, and T20 increased with meal size, regardless of diet type or water intake. Gastric emptying of a dry diet meal took significantly (P < 0.05) longer than that of an isocaloric meal of canned diet, except when meal size was small. Differences in gastric emptying of dry and canned diets varied with the phase (T90 vs T50 vs T20) of emptying. Conclusion Water intake, meal size, and diet type significantly influence gastric emptying in healthy cats, and these factors must be considered in analysis of gastric emptying data. (Am J Vet Res 1998;59:388–392)

Improved nutrition after the detection and treatment of occult gastroparesis in nondiabetic dialysis patients

Malnutrition in dialysis patients is of multifactorial etiology and is associated with greatly increased morbidity and mortality. A low serum albumin level is one of the most powerful predictors of death and may persist despite optimization of the dialysis prescription. We retrospectively reviewed our experience in improving nutrition in nondiabetic patients with unexplained hypoalbuminemia. Using radionuclide solid-phase gastric emptying scans, we identified 6 patients who had occult gastroparesis. These patients (one on hemodialysis and five on peritoneal dialysis) were then treated with prokinetic medications (erythromycin elixir or metoclopramide) selected on the basis of their effectiveness in improving the scanning results after being given intravenously. Gastric emptying half-times improved from a median of 122 minutes (range, 95 to >300 minutes; normal, < or = 90 minutes) to 12 +/- 2 minutes (mean +/- SEM). The serum albumin increased from 3.3 +/- 0.04 g/dL to 3.7 +/- 0.08 g/dL at 3 months, with every patient's value higher than 3.5 g/dL. This improvement was statistically significant (P = 0.008) over the 5-month period of observation, which encompassed the 2 months before and 3 months after treatment. There was a linear improvement (P = 0.008) that showed a quadratic trend (P = 0.078) for a plateau at the final sampling point. The serum blood urea nitrogen, creatinine, and hematocrit levels remained unchanged (P > 0.1). We conclude that gastric emptying scans are valuable in identifying occult gastroparesis in high-risk patients and can guide the selection of prokinetic therapy, which may significantly increase serum albumin levels. (Am J Kidney Dis 1998 Jan;31(1):62-6)

Dumping syndrome following Nissen fundoplication, diagnosis, and treatment.

We evaluated the prevalence, diagnosis, and treatment of dumping syndrome (DS) following Nissen fundoplication in 50 consecutive infants and children who underwent the operation for gastroesophageal reflux. Examination included a preoperative dietary assessment with emphasis on specific postprandial clinical symptoms and technetium scintigraphy to evaluate gastric emptying. In the immediate postoperative period, postprandial glucose levels were examined in all patients with symptoms clinically suggestive of DS. In the late postoperative period (6 months to 5.5 years), all patients with more than one specific clinical symptom of DS were further evaluated by glucose tolerance test (GTT), HbA1C levels, and gastric technetium scintigraphy. DS was diagnosed in 15 patients (30%). Five patients had immediate severe DS (SDS), and 10 in the late postoperative course had latent postoperative DS (LDS). In all patients with DS, preoperative and postoperative gastric emptying scan T1/2 did not show any statistical significance. High levels of HbA1C ranging from 7.9 to 9% (mean, 8.25 +/- 0.5) were found in only three patients. Treatment included parenteral nutrition in one patient. All the others were successfully managed with nutritional manipulation alone, using a combination of lactose-free formula and fat emulsion. In patients whose postprandial symptoms persisted, pectin 5-15 g/day divided into six doses was added to the diet. Following 6 months of dietary treatment, the postprandial normoglycomic response was restored. Eleven patients experienced complete resolution of symptoms (78.5%), and three patients (21.4%) showed significant clinical improvement. This study indicates that DS is a common complication following Nissen fundoplication. The GTT is the most reliable examination for establishing the diagnosis. Treatment is simple and effective. The technetium gastric emptying scan and HbA1C level do not play a significant role in the diagnosis.

The functional relationships between hiatal hernia and reflux esophagitis.

The purpose of this research was to investigate functional studies by which the hiatal hernia (HH) may be relevant to a reflux esophagitis (RE). Group I consisted of healthy controls who were endoscopically normal (n = 21). Group II consisted of patients with hiatal hernia but no reflux esophagitis (n = 8). Group III had patients with hiatal hernia with reflux esophagitis (n = 9). Group IV had patients with reflux esophagitis but no hiatal hernia (n = 16). Esophageal manometry, ambulatory 24 hour intraesophageal pH monitoring, acid clearance test, and gastric emptying scan were performed in each of the patients. The contraction amplitude at 3 cm above the lower esophageal sphincter did not differ significantly among the four groups, but the mean lower esophageal sphincter pressure was significantly decreased in group II. The DeMeester score in ambulatory 24 hour intraesophageal pH monitoring was significantly higher in group III compared with the controls. No significant difference among the groups was found with respect to acid clearance. Total and proximal gastric emptying times (T1/2) were significantly delayed in group III. We found that hiatal hernia combined with delayed gastric emptying may bear a relationship to the multifactorial origins of reflux esophagitis, and we suggest a rationale for using prokinetic agents as the therapeutic regimen in patients with HH complicated by RE.

Pathologic duodenogastric reflux associated with persistence of symptoms after cholecystectomy

The aim of this study was to determine whether increased duodenogastric reflux contributes to postcholecystectomy symptoms. Gastric pH monitoring, hepatobiliary scintigraphy, gastric emptying scans, and gastric acid analysis were performed in asymptomatic (n = 10) and in symptomatic (n = 27) patients after cholecystectomy. Normal subjects (n = 20), patients with dyspepsia related to gastric acid hypersecretion (n = 20), patients with reflux gastritis after gastric surgery (n = 10), and patients with confirmed primary pathologic duodenogastric reflux (n = 10) were studied as controls. Symptomatic patients also underwent upper gastrointestinal endoscopy. Symptomatic patients had significantly increased interprandial gastric exposure to pH < 3 compared with asymptomatic subjects, which correlated well with a high incidence of hepatobiliary scans positive for abnormal duodenogastric reflux and chronic gastritis on endoscopy. Gastric alkaline exposure in symptomatic patients was similar to that seen in patients with primary pathologic duodenogastric reflux and patients with duodenogastric reflux related to gastric surgery. Gastric acid secretion and gastric emptying were not altered. Five patients tested before and after laparoscopic cholecystectomy showed that nocturnal gastric alkalization was enhanced after operation. This study suggests that excessive duodenogastric reflux may be responsible for persistence of symptoms after cholecystectomy.

Similar Gastric Emptying Rates for Casein- and Whey-Predominant Formulas in Preterm Infants

Casein-predominant infant milk formulas have been speculated to predispose to lactobezoar formation in preterm infants due to delayed gastric emptying. There have been, however, no prospective studies to prove this possibility. In a randomized, double-blinded, prospective study, we tested the hypothesis that preterm infants fed casein-predominant milk formula have slower gastric emptying than infants fed whey-predominant formulas. Twenty preterm infants within the first 4 d of life were randomized to receive either the whey-predominant formula Similac Special Care (whey:casein ratio 60:40) or an experimental casein-predominant formula (whey:casein ratio 18:82). Only the protein composition differed between the two formulas. The infants were fed the assigned study formula until they reached approximately 2200 g body weight when a gastric emptying scan was performed, using the designated study formula mixed with 25 microCi of technetium-99 sulfur colloid. Gastric emptying was followed continuously for 2 h. Gastric emptying at 30, 60, 90, and 120 min was similar between the two study groups. The time for 50% gastric emptying was 64.9 +/- 12.3 min for the infants fed the whey-predominant formula and 56.5 +/- 14.8 min for those fed the casein-predominant formula (p = 0.75). We conclude that the rate of gastric emptying in preterm infants fed casein-predominant formulas is similar to that in those fed whey-predominant formulas.

Delayed gastric emptying in neurologically impaired children with gastroesophageal reflux: The role of pyloroplasty

The presence of delayed gastric emptying in neurologically impaired children with gastroesophageal reflux has led to controversy regarding appropriate surgical management. The authors reviewed the charts of neurologically impaired children requiring fundoplication to answer two questions: (1) is pyloroplasty needed in addition to fundoplication for delayed gastric emptying? and (2) Does delayed gastric emptying influence the morbidity associated with fundoplication? To answer the first question, 40 neurologically impaired children with delayed gastric emptying undergoing fundoplication were divided into two groups: Nissen and pyloroplasty (n = 21) and Nissen only (n = 19). The Nissen and pyloroplasty group had significantly more postoperative complications (23.8% v 5.0%) and took longer to reach full feeding (14.6 v 3.9) days. There were no differences in the incidence of recurrent symptoms, readmissions, or reoperations. To answer the second question, 58 neurologically impaired children undergoing fundoplication were grouped based on gastric emptying scan results: normal gastric emptying (>32% in 1 hour) (n = 29) and delayed gastric emptying (n = 29). There were no differences in postoperative feeding tolerance, postoperative complications, recurrent symptoms, readmissions, or reoperations between the two groups. Delayed gastric emptying in neurologically impaired children with gastroesophageal reflux did not increase postoperative morbidity after fundoplication, and the addition of a pyloroplasty to fundoplication provided no additional benefit. The authors conclude that the procedure of choice for neurologically impaired children with gastroesophageal reflux is a fundoplication without pyloroplasty, regardless of the degree of delay in gastric emptying.

Autonomic neuropathy in AL (primary) amyloidosis and its effect on survival

The significance of autonomic neuropathy (AN) in primary amyloidosis (AL) is unknown. We describe features of AN in 112 AL patients enrolled in a clinical trial. Those with orthostatic hypotension [drop in systolic/diastolic blood pressure (BP) of220/10 mmHg and increase in pulse of <10 beats/min.J were defined as having definite AN. Patients with two or more abnormal results on autonomic testing fexpiration. inspiration ratio, Valsalva and posture indices, increase in diastolic BP with handgrip, increase in systolic BP with standing], were also defined as having definite AN. Patients with abnormal gastric emptying scans and two nongastroenterologic symptoms of AN (dry eyes and mouth, urinary retention symptoms, impotence) were defined as having possible AN.Of a total of 112 patients, twenty-six patients (23%) were defined as having either definite AN (22 patients) or possible AN (4 patients). Among patients with definite or possible AN, signs and symptoms included orthostasis (69%), early satiety (50%), ...

Efficacy of Domperidone in Infants and Children with Gastroesophageal Reflux

This study sought to define the therapeutic efficacy of domperidone in infants and children with gastroesophagcal reflux. A double‐blind, placebo‐controlled trial was performed in seventeen children (ages 5 months to 11.3 years) with moderate to severe gastroesophagcal reflux who had not responded to standard nonpharmacological therapy. Subjective and objective measures (weight gain, esophageal pH probe study, radionuclide gastric emptying scan) of gastroesophageal reflux were evaluated. Therapy with domperidone for 4 weeks was effective only in reducing the total number of reflux episodes in the two‐hour postprandial period (p &lt; 0.01); however, it did not result in symptomatic improvement or significant improvement in other measures of gastro‐esophageal reflux or gastric emptying. After therapy for 8 weeks symptomatic improvement was reported in some patients who had denied improvement after 4 weeks of therapy, suggesting that more than 4 weeks of therapy may be required for some patients to obtain a clinical response. Mild self‐limited diarrhea was reported by six patients (four domperidone, two placebo). We conclude that domperidone is tolerated by most infants and children with gastroesophageal reflux; however, 4 weeks of therapy was only minimally effective in producing objective improvement of gastroesophageal reflux and did not result in symptomatic improvement. Further studies of longer duration are needed to resolve the question raised by this study: that domperidone may be beneficial for patients with gastroesophageal reflux when given for more than four weeks.

Erythromycin stearate as prokinetic agent in postvagotomy gastroparesis

We describe a patient with severe postvagotomy gastroparesis who failed standard medical therapy but had an excellent clinical and radiological response to 250 mg of erythromycin administered 30 min before each meal. Improvement was further documented by a marked improvement in this patient's 99m Tc-sulfur colloid radionuclide gastric emptying scan

Chronic nausea and anorexia in advanced cancer patients: a possible role for autonomic dysfunction.

Abstract Five patients with advanced cancer who complained of unexplained chronic (more than fourweeks) nausea and anorexia, underwent a gastric emptying scan and clinical and electrocardiographic tests for the detection of autonomic failure. Sixteen of 23 tests were abnormal in the patients, v 0 of 25 in five healthy adult controls (p