Simple clinical method of measuring gastric emptying of solid meals.

The radioisotope techniques used for the measurement of gastric emptying of solid meals in man require complex and expensive scintiscanners of cameras. We have evaluated a simple technique which uses a fixed scintillation detector and compared the results with those obtained from a gamma camera. The rates and patterns of gastric emptying recorded by the two methods correlated well in both healthy volunteers (mean r= 0.95) and patients with duodenal ulcer (mean r =0.89). The scintillation detector provides a reliable and inexpensive method for measurement of gastric emptying of solid meals.     

Evaluation of Gastric Emptying Measured with the 13 C-octanoic Acid Breath Test in Patients with Functional Dyspepsia: Comparison with Ultrasonography

Background: As a non-invasive modality by which to evaluate the gastric emptying of a solid meal, the 13C-octanoic acid breath test has recently become more widely used. Previously, we reported that ultrasonography was another non-invasive and reliable method for assessing gastric motility. The aim of this study was to compare the reliability of these two methods. Methods: Seventeen patients with functional dyspepsia and 10 healthy volunteers were studied. The solid test meal consisted of a scrambled egg labeled with 13 C-octanoic acid (100 mg) and served with a bowl of rice and boiled chicken (total 424 kcal). After ingestion of the test meal, all subjects were examined in the sitting position. Ultrasonography images were obtained every 15 min for 3 h. Breath sampling followed the same time schedule as for the ultrasonography, with an additional 3 h of sampling at 30-min intervals. We investigated the half emptying time (T1/2) and the lag phase with both methods. Results: The T1/2 by the ultrasonography method and the breath test were positively correlated ( r 2 = 0.638); however, there was no significant agreement between the study groups. Both the T1/2 and the lag phase were prolonged in the functional dyspepsia patients compared with the healthy volunteers, regardless of the method of measurement. The lag phase was significantly correlated ( r 2 = 0.864) with the T1/2 by the breath test. Conclusions: Although the 13 C-octanoic acid breath test cannot assess the gastric emptying of solids as reliably as ultrasonography, both tests are useful for evaluating functional dyspepsia patients with delayed gastric emptying.     

Evaluation of gastric emptying measured with the 13C-octanoic acid breath test in patients with functional dyspepsia: comparison with ultrasonography

BACKGROUND: As a non-invasive modality by which to evaluate the gastric emptying of a solid meal, the 13C-octanoic acid breath test has recently become more widely used. Previously, we reported that ultrasonography was another non-invasive and reliable method for assessing gastric motility. The aim of this study was to compare the reliability of these two methods. METHODS: Seventeen patients with functional dyspepsia and 10 healthy volunteers were studied. The solid test meal consisted of a scrambled egg labeled with 13C-octanoic acid (100 mg) and served with a bowl of rice and boiled chicken (total 424 kcal). After ingestion of the test meal, all subjects were examined in the sitting position. Ultrasonography images were obtained every 15 min for 3 h. Breath sampling followed the same time schedule as for the ultrasonography, with an additional 3 h of sampling at 30-min intervals. We investigated the half emptying time (T1/2) and the lag phase with both methods. RESULTS: The T1/2 by the ultrasonography method and the breath test were positively correlated (r2 = 0.638); however, there was no significant agreement between the study groups. Both the T1/2 and the lag phase were prolonged in the functional dyspepsia patients compared with the healthy volunteers, regardless of the method of measurement. The lag phase was significantly correlated (r2=0.864) with the T1/2 by the breath test. CONCLUSIONS: Although the 13C-octanoic acid breath test cannot assess the gastric emptying of solids as reliably as ultrasonography, both tests are useful for evaluating functional dyspepsia patients with delayed gastric emptying.     

Effect of nifedipine on gastric emptying and gastrointestinal motility in man

Nifedipine, a calcium-blocking agent, inhibits smooth muscle contractions in various organs including gastric muscle in vitro. Despite this, nifedipine has been found to have no effect on gastric emptying in man. We have investigated the effect of nifedipine on gastric emptying of liquids and solids and on gastrointestinal motility in six healthy subjects. For this, isotopic techniques and manometric methods were used. We confirm that nifedipine 30 mg per os does not modify gastric emptying of liquids or solids. By contrast, antra motility was significantly inhibited (P<0.05) and duodenal motility increased. These results could be interpreted as (1) gastroduodenal motility changes are not severe enough to alter emptying or (2) isotopic techniques are not sensitive enough to detect subtle changes in gastric emptying.     

Gastric emptying: comparison of scintigraphic, polyethylene glycol dilution, and paracetamol tracer assessment techniques

BACKGROUND: The method of choice for studying gastric emptying is dependent on several factors. The aim of the present study was to assess the concordance between solid gastric emptying, using a scintigraphic technique as gold standard, and gastric emptying as measured with parcetamol tracer and polyethylene glycol (PEG) dilution. METHODS: Two groups of seven male volunteers with similar ages and weights were studied, one for scintigraphic (310-kcal omelette with 12-15 MBq 99mTc-labeled macroaggregated albumin) and paracetamol (1.5 g dissolved in water and administered concomitantly with the omelette) and one for the marker dilution study (PEG 4000 dissolved in a 310-kcal meal). RESULTS: The gastric half-emptying time (T50) was shorter in the PEG study than in the scintigraphic test (47.5 (37.5-62) versus 68.1 (43.6-89.4), median (range) (P < 0.05), respectively), whereas there was no significant difference between the T50 for gastric emptying as assessed with the scintigraphic and paracetamol tracer methods. No difference in gastric emptying rate using PEG dilution or paracetamol tracer was obtained. CONCLUSIONS: In summary, this study shows that scintigraphic, paracetamol tracer, and PEG dilution methods can all be used to assess gastric emptying. The use of the paracetamol tracer technique offers a relatively inexpensive technique that yields a good approximation of gastric emptying as verified by the scintigraphic emptying of a solid meal.     

Gastric emptying: a comparison of three methods

OBJECTIVE: A better understanding of the clinical relevance of delayed gastric emptying (e.g. in diabetes) requires a simple, easily accessible and inexpensive method for measuring it. Two "new" methods for measuring gastric emptying of liquids (the paracetamol absorption test and the 13C-acetate breath test) are compared with the gold standard (gastric emptying scintigraphy (GES)). MATERIAL AND METHODS: The three techniques were used simultaneously in 10 healthy subjects. A gastric emptying time-retention curve was drawn for each technique and the results were compared at the 75%, 50% and 25% retention quartiles. RESULTS: Agreement was found between the paracetamol absorption test and GES (p=0.95; Hotelling's T 2 test). Using the Wagner-Nelson one compartment correction produced a retention curve for the 13C-acetate breath test statistically significantly below GES (p<0.01). CONCLUSION: In healthy subjects, the paracetamol absorption test produced results comparable to those of liquid GES, but not to the results of the 13C-acetate breath test.     

Measurement of gastric emptying rate in humans

Simultaneous measurements of the gastric emptying rate of the solid and liquid phase of a dual-isotope-labeled test meal were made using a gamma camera and a simple scintillation detector, similar to that used in a hand-held probe. A simple scanning apparatus, similar to that used in a hand-held scintillation probe, was compared with simultaneous measurements made by a gamma camera in 16 healthy males. A dual-labeled test meal was utilized to measure liquid and solid emptying simultaneously. Anterior and posterior scans were taken at intervals up to 120 min using both a gamma camera and the scintillation probe. Good relative agreement between the methods was obtained both for solid-phase (correlation range 0.92-0.99, mean 0.97) and for liquid-phase data (correlation range 0.93-0.99, mean 0.97). For solid emptying data regression line slopes varied from 0.75 to 1.03 (mean 0.84). Liquid emptying data indicated that slopes ranged from 0.71 to 1.06 (mean 0.87). These results suggested that an estimate of the gamma measurement could be obtained by multiplying the scintillation measurement by a factor of 0.84 for the solid phase and 0.87 for the liquid phase. Correlation between repeat studies was 0.97 and 0.96 for solids and liquids, respectively. The application of a hand-held probe technique provides a noninvasive and inexpensive method for accurately assessing solid- and liquid-phase gastric emptying from the human stomach that correlates well with the use of a gamma camera, within the range of gastric emptying rate in the normal individuals in this study.     

13C-Bicarbonate Breath Test as a Measure of Gastric Emptying

Radionuclide studies are widely used to estimate the gastric emptying rate of solids and liquids. Unfortunately, these methods carry the risk of radiation exposure and require expensive and complex equipment. Carbon-13, a stable, nonradioactive isotope, has been used successfully as a marker in the gastrointestinal tract for other purposes. A preliminary study using ingested NaH13CO3 and measuring 13CO2 breath excretion suggested that this test might be a simple, noninvasive, and inexpensive method for determining gastric emptying. To determine the efficacy of NaH13CO3 as a noninvasive marker for gastric emptying, the resulting 13CO2 breath excretion was determined simultaneously with standard radiolabeled meal measurements of gastric emptying of liquids and solids in 15 patients. 13CO2 breath excretion did not correlate with the gastric emptying of either solids or liquids, as determined by radionuclide techniques. These results suggest that NaH13CO3 is not a reliable indicator of gastric emptying. Factors other than gastric emptying may affect the rate of 13CO2 absorption and exhalation, rendering it unreliable as a measure of gastric emptying.     

Relationship between gastric emptying of a solid meal and emptying of the gall bladder before and after vagotomy.

Little is known of the temporal and quantitative relationships between emptying of the stomach and of the gall bladder in patients with duodenal ulcer before and after vagotomy. A non-invasive double isotope technique was used to investigate these relationships in 27 patients with a duodenal ulcer, before and after operation-truncal vagotomy and pyloroplasty (TV + P; n = 15) and highly selective vagotomy (HSV; n = 12). A further 25 patients were studied after operation (TV + P, n = 20: HSV, n = 5). 99Tcm-EHIDA was used as the biliary tracer and 113Inm bran as the gastric content tracer. In patients with a duodenal ulcer before surgery and in 16 of the 17 patients studied after HSV, the patterns of gall bladder emptying were similar to those previously found in normal subjects. In 60% of patients after TV + P, patterns of gall bladder emptying were altered and the onset of gall bladder emptying was significantly delayed (p less than 0.001) compared with unoperated patients and patients with a HSV. The rate of gall bladder emptying did not correlate with the rate of gastric emptying in any of the patients studied. These observations suggest that TV + P, but not HSV, causes considerable alteration in coordination of gall bladder and gastric emptying.     

Measurement of gastric emptying by real-time ultrasound.

A safe non-invasive technique for the measurement of gastric volume by real-time ultrasound is described. The application of this technique to the measurement of the emptying of liquid from the stomach is outlined. Gastric emptying of liquid was found to be log-linear, the mean half-life of emptying in 10 volunteers being 22 . 0 +/- 2 . 5 min. Ultrasound measurement of gastric emptying provides an opportunity to study the effects of drugs and disease on gastric motor function in man.     

Real-time ultrasonographic assessment of antroduodenal motility after ingestion of solid and liquid meals by patients with functional dyspepsia

BACKGROUND AND AIMS: Although antroduodenal motility has usually been studied by using manometric or scintigraphic methods, ultrasonography is an established, non-invasive method to evaluate duodenogastric motility. We used ultrasonography to evaluate gastric motility in patients with functional dyspepsia. METHODS: Sixty-four patients with functional dyspepsia and 36 asymptomatic healthy subjects were given liquid and solid test meals. We investigated the gastric emptying rate, motility index, and duodenogastric reflux for the liquid meal and gastric emptying time, half-emptying time, and motility index for the solid meal. RESULTS: After the liquid meal, the gastric emptying rate and motility index were significantly lower and the duodenogastric reflux was significantly higher in functional dyspepsia patients than in healthy subjects. After the solid meal, gastric emptying time, half-emptying time and the motility index were significantly lower in the patients than in the healthy subjects. Delayed gastric emptying of both meals occurred in only 20.3% of patients. Delayed emptying of the liquid or solid meal occurred in 62.5% of patients. In both groups, gastric emptying time of the solid meal was positively correlated with the motility index at 15 min post-ingestion. CONCLUSION: In functional dyspepsia patients, delayed gastric emptying of a solid meal was related to antral hypomotility during the early postprandial phase. Ultrasonographic assessment of gastric motility in both liquid and solid meals may provide a better understanding of the pathogenesis of functional dyspepsia.     

Measurement by epigastric impedance of gastric emptying in diabetic autonomic neuropathy

Changes in impedance across the epigastrium form the basis of a new non-invasive method of assessing gastric emptying of liquids. The apparatus is simple to use at the bedside and, in conjunction with conventional investigations, is of value in diagnosing gastroparesis in patients with diabetic autonomic neuropathy and symptoms of recurrent vomiting. We measured gastric emptying of liquids in 22 diabetics aged 33.4 +/- 9 years (mean +/- SD) with severe symptomatic autonomic neuropathy (mean heart rate variability 4.9 +/- 2.2 SD beats/min), and 15 normal controls. Median 'half emptying' time in the diabetics with autonomic neuropathy was prolonged overall but it was not always abnormal (12.25 min, range 6.5-greater than 30 compared to 8.0 min, range 3-17; p less than 0.01). Results in five diabetics with symptoms of recurrent vomiting corresponded with those using conventional radiological methods, confirming gastroparesis in three instances and excluding it in two. The effect of metoclopramide was also studied and was shown to accelerate gastric emptying in some but not all of the patients. Assessment of gastric emptying using the impedance method assists in establishing the diagnosis of gastroparesis and is of value for repeated measurements.     

Gastric emptying: a comparison of three methods

Objective. A better understanding of the clinical relevance of delayed gastric emptying (e.g. in diabetes) requires a simple, easily accessible and inexpensive method for measuring it. Two “new” methods for measuring gastric emptying of liquids (the paracetamol absorption test and the ¹³C-acetate breath test) are compared with the gold standard (gastric emptying scintigraphy (GES)). Material and methods. The three techniques were used simultaneously in 10 healthy subjects. A gastric emptying time-retention curve was drawn for each technique and the results were compared at the 75%, 50% and 25% retention quartiles. Results. Agreement was found between the paracetamol absorption test and GES (p=0.95; Hotelling's T² test). Using the Wagner-Nelson one compartment correction produced a retention curve for the ¹³C-acetate breath test statistically significantly below GES (p<0.01). Conclusion. In healthy subjects, the paracetamol absorption test produced results comparable to those of liquid GES, but not to the results of the ¹³C-acetate breath test.     

Postprandial blood glucose and its relation to diabetic gastroparesis — a comparison of two methods

Delayed gastric emptying is known as an important organic cause for brittle diabetes. We proposed the interval from the start of a meal to the rise in blood glucose, defined as blood glucose latency (T BG) as an index for gastric emptying and a non-invasive test for diabetic gastropathy. In order to validate this test we compared it in 22 type 1 diabetic patients with an established scintigraphic method for the measurement of gastric half-emptying time (T_1/2) and found the following correlation: T BG = 4.4 + 0.162 × T_1/2; r 0.79, P < 0.001. We therefore suggest measuring the blood glucose latency as a simple non-invasive screening method.     

Comparison of aspiration and scintigraphic techniques for the measurement of gastric emptying rates of liquids in humans.

A comparison was made of two techniques to measure the rate of gastric emptying. A noninvasive scintigraphic technique using a gammacamera and an invasive aspiration technique based on dye dilution were performed simultaneously. Seven healthy male volunteers each consumed two different liquid meals on two separate occasions. Scintigraphic measurements were performed continuously with aspiration every 10 minutes for a total of one hour. Gastric emptying rates were expressed as slope values after semilog linearisation of the emptying curves. Agreement between the two methods was assessed from the individual differences and mean of the two techniques, as well as from the geometric mean, including 95% limits of agreement. The scintigraphic technique gave a 70% slower emptying rate than the dye dilution technique. However, the 95% limits of agreement are large (1.56 to 0.30), reflecting the small sample size and the large coefficient of variation in the techniques used.     

Diabetes mellitus and gastric emptying: questions and issues in clinical practice

It is long known that both type 1 and type 2 diabetes can be associated with changes in gastric emptying; a number of publications have linked diabetes to delayed gastric emptying of variable severity and often with poor relationship to gastrointestinal symptomatology. In contrast, more recent studies have reported accelerated gastric emptying when adjusted for glucose concentration in patients with diabetes, indicating a reciprocal relationship between gastric emptying and ambient glucose concentrations. This review proposes that gastroparesis or gastroparesis diabeticorum, a severe condition characterized by a significant impairment of gastric emptying accompanied by severe nausea, vomiting, and malnutrition, is often overdiagnosed and not well contrasted with delays in gastric emptying. The article offers a clinically relevant definition of gastroparesis that should help differentiate this rare condition from (often asymptomatic) delays in gastric emptying. The fact that delayed gastric emptying can also be observed in non‐diabetic individuals under experimental conditions in which hyperglycaemia is artificially induced suggests that a delay in gastric emptying rate when blood glucose concentrations are high is actually an appropriate physiological response to hyperglycaemia, slowing further increases in blood glucose. The article discusses the strengths and weaknesses of various methodologies for assessing gastric emptying, especially with respect to the diabetes population, and reviews newer diabetes therapies that decelerate the rate of gastric emptying. These therapies may be a beneficial tool in managing postprandial hyperglycaemia because they attenuate rapid surges in glucose concentrations by slowing the delivery of meal‐derived glucose. Copyright © 2009 John Wiley & Sons, Ltd.     

Effects of Helicobacter pylori eradication therapy on gastric emptying measured using the 13C-octanoic acid breath test and the acetaminophen method

BACKGROUND: The relationship between Helicobacter pylori eradication and gastric emptying has been reported; however, the effect of eradication therapy on gastric emptying is still unclear. This study evaluated the relationship between three gastric emptying techniques, the scintigraphic technique, the 13C-octanoic acid breath test, and the acetaminophen method, measured simultaneously, and the effect of H. pylori eradication therapy on gastric emptying and abdominal symptoms in patients with functional dyspepsia who were H. pylori positive. METHODS: Fifty-three consecutive patients with positive H. pylori infection were enrolled in this study. In the first 14 patients, gastric emptying was measured using the three gastric emptying techniques. In 42 patients cured of H. pylori infection, the 13C-octanoic acid breath test and the acetaminophen method were performed before and 3 months after eradication. RESULTS: Significant correlations were found between the scintigraphic technique, the 13C-octanoic acid breath test, and the acetaminophen method. Gastric emptying determined by the 13C-octanoic acid breath test and the acetaminophen method was not changed after eradication, on average. In 14 (33.3%) patients a decrease in symptom score after eradication was observed. In four (9.5%) patients, accelerated gastric emptying after eradication may have led to a reduction in the abdominal symptoms. CONCLUSIONS: The 13C-octanoic acid breath test and the acetaminophen method are appropriate for investigating gastric emptying. A causal relationship between improvement of symptoms and accelerated gastric emptying was not found, and the efficacy of H. pylori eradication therapy in patients with functional dyspepsia was minimally exhibited.     

Determination of total gastric volume, gastric secretion and residual meal using the double sampling technique of George.

In literature several techniques are described for the measurement of gastric emptying. One of these is the double sampling technique of George which has the advantage that it enables multiple measurements of total gastric volume in one experiment. In order to estimate net gastric emptying, however, it is important to differentiate between the test meal volume present in the stomach and gastric secretion. In the present study George's technique was extended with a calculation procedure to estimate gastric secretion and net test meal outflow. An in vitro experiment was carried out which showed an accuracy of 5-10% for this method. An in vivo comparison was made with Hunt's chloride technique, which is used for estimating gastric secretion. Sixteen subjects participated in a 60 minute test with water as a test meal. Regression analysis showed a high degree of correlation (R2 = 0.99) between Hunt's method and the proposed method. The data obtained indicate that the proposed method gives a reliable estimation of net gastric emptying and is simple to do as no further measurements have to be carried out other than those needed for George's method.     

Diagnosis of rectal cancer by Tissue Resonance Interaction Method

Background  

Since population screening has the potential to reduce mortality from rectal cancer (RC), novel methods with improved cost-effectiveness warrant consideration. In a previous pilot study, we found that the rapid, inexpensive and non-invasive electromagnetic detection of RC is a highly specific and sensitive technique. The aim of the present prospective study was to evaluate the prediction accuracy of electromagnetic detection of RC.     

Effect of atropine sulfate on gastric emptying and gastrocecal transit time evaluated by using the [1-(13)C]acetic acid and lactose-[(13)C]ureide breath test in conscious rats

Breath tests have been used to investigate many physiological functions. Recently, we have developed a breath test system by using a non-invasive technique in conscious rats. In this study, we investigated the effect of atropine sulfate on the gastric emptying and gastrocecal transit time using [1-(13)C]acetic acid and lactose-[(13)C]ureide, respectively. Gastric emptying was significantly delayed by atropine sulfate in a dose-dependent manner (0.03-0.3 mg kg(-1)), but the effects of 0.1 and 0.3 mg kg(-1) were almost equal. C(max) and T(max) values were also significantly and dose-dependently decreased and delayed, respectively. However, AUC(120 min) values were not significantly different for the three doses of atropine sulfate. This suggests that although atropine sulfate slows the emptying of the gastric content, it is excreted eventually to the same content as the control. The gastrocecal transit time was significantly delayed by atropine sulfate at a dose of 1 mg kg(-1), but not at a dose of 0.1 mg kg(-1). These findings demonstrate that the breath tests can evaluate the effect of atropine sulfate on the gastric emptying and gastrocecal transit time. The effective dose of atropine sulfate may be different for gastric emptying and gastrocecal transit time.