Evaluation of reproducibility of solid-phase gastric emptying in healthy subjects

Radionuclide gastric emptying studies are performed as a matter of clinical routine. Our aim was to evaluate the inter- and intra-individual variability and the reproducibility of gastric emptying studies in healthy young male volunteers using a single solid-phase, standard meal. The meal consisted of a pancake (500 KJ) tagged with technetium 99m sulphur colloid and no additional liquid. Continuous acquisitions of gastric activity in anterior projection were taken during 90 min, starting from the onset of the meal. Gastric emptying was evaluated three times in a 3-week period. Five different parameters were evaluated. Our results show that there is important inter- and intra-individual variability in normal volunteers. In spite of this variability, no significant difference between the different series of gastric emptying studies was observed.     

胃排空动态显像中双核素标准餐的应用

目的研究１３１Ｉ小牛血清白蛋白（ＢＳＡ）和９９ｍＴｃＤＴＰＡ双核素胃排空动态显像的方法及探讨其临床应用价值。方法用前临时标记１３１ＩＢＳＡ和９９ｍＴｃＤＴＰＡ，配成１３１ＩＢＳＡ鸡蛋固体餐和９９ｍＴｃＤＴＰＡ水液体餐。固体餐经人胃液消化试验，检测标记物稳定性。检查３５例慢性胃炎病人和１０例健康志愿者的胃排空功能，其中２例在３天内进行了１３１ＩＢＳＡ鸡蛋餐和９９ｍＴｃ硫胶体（Ｓｃ）鸡肝餐两法对照，比较其相关性。结果１３１ＩＢＳＡ和９９ｍＴｃＳｃ在胃液中消化２小时，脱标率分别为３００％和５１６％；１３１ＩＢＳＡ鸡蛋餐法和９９ｍＴｃＳｃ鸡肝餐法相关性好，ｒ＝０９８９，Ｐ＜００１；对照组固相半排空时间（ＨＳＥＴ）为５８２±１７７分钟，液相半排空时间（ＨＬＥＴ）为２３５±９４分钟；病例组ＨＳＥＴ为９２５±２９６分钟，ＨＬＥＴ为３７２±１６６分钟；固相和液相两组差异均有显著性（ｔ＝３４７４和２４８５，Ｐ＜００１）。结论１３１ＩＢＳＡ鸡蛋餐、９９ｍＴｃＤＴＰＡ液体餐同时使用（双核素标准餐法）可为临床提供胃排空固体和液体食物的情况     

Technetium-99m carboxymethylcellulose: A newly developed fibre marker for gastric emptying studies

We report a study of technetium-99m-labelled carboxymethyl-cellulose (^99mTc-CMC) as a newly developed non-digestible marker of the solid phase of gastric contents. The radiosynthesis is simple and shows a high labelling efficiency. In vitro and in vivo experiments demonstrated stability of the marker in the gastrointestinal tract during the process of gastric emptying. The gastric half-emptying time in ten healthy volunteers of both sexes was 105 ± 17 min (mean ± SD). This rate of gastric emptying is similar to that of non-digestible solid-phase markers such as in vivo labelled^99mTc-chicken liver or radio-iodinated cellulose. In comparison with digestible solid-phase markers such as^99mTc-labelled pancake or^99mTc-cooked egg, gastric emptying of^99mTc-CMC occurred more slowly, confirming the expected behaviour of a non-digestible solid-phase marker. We conclude that^99mTc-CMC has the advantage of a simple and rapid labelling procedure and may be useful for clinical studies of gastric emptying.     

A case of gastric duplication evaluated by gastric emptying scintigraphy

Gastric duplications are relatively rare, and communication with the gastric lumen is extremely rare. A 67-year-old man was referred to our hospital because of recurrence of epigastric pain and fullness. An upper gastrointestinal contrast study revealed a double compartment stomach, with gastric duplication starting at the esophagogastric junction outside the greater curvature. Computed tomography of the stomach with gastrografin as contrast demonstrated complete communication of the gastric duplication and primary stomach. The patient was diagnosed with complete gastric duplication. Gastric emptying scintigraphy with Tc-99m diethyltriamine pentaacetic acid was performed. Test meal entered the primary stomach and duplication cyst simultaneously, and radioactivity in the primary stomach decreased linearly and gastric emptying was not delayed. In the duplication cyst, about 70% of the food that entered the cyst once was immediately evacuated from it, but the remaining 30% remained in the cyst for a long time. Gastric emptying of the primary stomach was not affected by formation of the duplication cyst.     

Magnetic resonance imaging in the evaluation of the gastric emptying and antral motion: Feasibility and reproducibility of a fast not invasive technique

Purpose

The aim of this study was to evaluate reproducibility of a fast MRI protocol to measure gastric emptying and motility of the gastric antrum.

Methods and materials

Gastric emptying and antral speed were measured in 12 type 1 diabetic patients (mean age 43 years) and 9 healthy volunteers (mean age 31 years). Subjects, fasting from 6 h, were evaluated in supine position using a 1.5 T MR scanner and a eight-channels phased-array body coil after ingestion of 400 ml of a vanillas pudding mixed with 5 ml of Gd-DTPA. Axial 3D T1w sequence at 0 and 30 min for volume evaluation and cine-steady state acquisition every 5 min for a total time of 30 min for gastric wave speed assessing were acquired. Two blinded observers extrapolated T½ from gastric volume assessment and speed of gastric waves.

Results

All the patients tolerated the examination. The T½ cut-off was of 115 min with an accuracy in differentiate controls from diabetics of 96% (95% CI 0.766-0.992; p < 0.001), while the antral speed cut-off was of 0.15 mm/s with an accuracy of 87% (95% CI 0.628-0.977; p < 0.001). The inter-observer agreement for the volumes at time 0 and 30 min was respectively 0.983 (95% CI 0.9628-0.9929; p < 0.001) and 0.9933 (95% CI 0.9847-0.9971; p < 0.001) with an agreement of 0.9918 (95% CI 0.9853-0.9954; p < 0.001), while for antral speed it was of 0.935 (95% CI 0.9097-0.9528; p < 0.001).

Conclusions

MRI is a reproducible technique for the evaluation of gastric emptying and antral motility.     

~(13)C-辛酸呼吸试验测定糖尿病胃固体排空功能的重复性研究

目的　观察13 C 辛酸呼吸试验测定糖尿病患者胃固体排空时间及其变异性 ,以及心自主神经病变和病理性胃排空状况对其的影响。方法　 9例对照者和 15例糖尿病患者 [平均糖基化血红蛋白 (HbA1c) 7 8% ]1周内行 2次13 C 辛酸呼吸试验 ,采用非线性回归法计算半排空时间 (t1/ 2 )和缓慢期时间 (tlag) ,同时采用心自主神经功能试验判断有无心自主神经病变。结果　对照组t1/ 2 批内CV为 11 7%、tlag批内CV为 19 4% ,糖尿病患者t1/ 2 批内CV为 17 8%、tlag批内CV为 2 8 2 % ,对照者和糖尿病患者间差异无显著性。t1/ 2 和tlag的批内CV在糖尿病患者伴有和无心自主神经病变之间以及在正常胃排空时间和延迟性胃排空时间之间差异无显著性。结论　13 C 辛酸呼吸试验测定胃固体排空功能有较高的重复性 ,并不受心自主神经病变和病理性胃排空的影响。     

用显示子检查不同胃型胃排空时间的对照研究

目的：不同胃型胃排空的对比研究，方法：1200例不同胃型健康志愿者，口服实验餐并连续观察显示子由胃排出的数目。结果：经统计学分析，瀑布型胃的胃排空与其它胃型有明显差异（P＜0．05）。结论：瀑布型胃属于一种潜病理（亚健康）状态。     

睡眠剥夺对大鼠胃动力及胃黏膜损伤的影响

 目的探讨睡眠剥夺对大鼠胃动力及胃黏膜损伤的影响.方法采用小站台水环境法建立大鼠睡眠剥夺模型.用同位素99mTc灌胃测定大鼠胃液体排空率,观察胃黏膜损伤情况.结果睡眠剥夺条件下可导致胃排空障碍,在睡眠剥夺第3日大鼠胃排空率明显下降(73.9±4.1)%,在睡眠剥夺第5天和第7天大鼠胃排空率降低更明显,(70.6±4.9)%,(70.4±5.9)%.同时胃黏膜损伤也不断加重,在睡眠剥夺第3日,第5天和第7天大鼠胃黏膜损伤指数分别为(25.7±3.2),(28.9±3.8),(31.1±4.3).结论睡眠剥夺可导致胃排空障碍和胃黏膜损伤,而且二者与睡眠剥夺时间密切相关.     

急性缺氧对飞行员胃液排空功能的影响

为探讨急性缺氧对飞行人员胃液体排空功能的影响，在常压下吸入不同浓度氧（17％、16％、14％、12％、10．5％及9％）的低氧混合气体30min，采用B型超声波在实验前后分别测量了64名男性飞行员的胃液体排空功能。结果表明，吸入17％低氧混合气胃排空延迟，但经统计学处理无显著性差异（P＞0．05），吸入16％以下的低氧混合气后胃排空延迟，经统计学处理有显著性差异（P＜O．01），且随着缺氧程度加重，胃液体排空时间延长更加明显。提示当发生高空缺氧时，应考虑到缺氧对胃排空有抑制作用这一因素。     

Comparison of total and compartmental gastric emptying and antral motility between healthy men and women

There is increasing evidence of gender-related differences in gastric emptying. The purpose of this study was first, to confirm the difference in gastric emptying for both solid and liquid test meals between healthy men and women, and secondly, to investigate the origin of this difference by studying regional gastric emptying and antral motility. A standard gastric emptying test with additional compartmental (proximal and distal) evaluation and dynamic imaging of the antrum was performed in 20 healthy women studied during the first 10 days of the menstrual cycle, and in 31 healthy age-matched men. In concordance with previous reports, women had a longer half-emptying time for solids as compared to men (86.2±5.1 vs 52.2±2.9 min, P<0.05). In our observations this seemed to be related to a significantly prolonged lag phase and a significant decrease in terminal slope. Dynamical antral scintigraphy did not show a significant difference. The distribution of the test meal within the stomach (proximal vs distal) showed more early proximal retention in women as compared to men. The terminal slope of the distal somach was significantly lower in women. We did not observe a significant difference in gastric emptying of the liquid test meal between men and women. Gastric emptying of solids is significantly slower in healthy women as compared to men. These findings emphasise the importance of using different normal values for clinical and research purposes in gastric emptying scintigraphy in men and women. The difference could not be explained by antral motility alone. Increased proximal retention and a lower terminal emptying rate in women are observations to be further investigated. Received 2 February and in revised form 17 April 1998     

Gastric emptying of two radiolabelled antacids with simultaneous monitoring of gastric pH

The aim of this study was to assess the gastric emptying rate of two antacids using an scintigraphic technique and simultaneous monitoring of gastric pH in 16 healthy male volunteers. Ten ml of Talcid (hydrotalcite 1 g) and Maalox (Mg-Al-hydroxide), with a similar neutralization capacity, were labelled with technetium-99m using a pyrophosphate bridge. Labelled antacids were given on separate days (within 2 weeks), 1 h after a standard meal. Intragastric pH was measured for at least 4 h, using ambulatory pH-metry with a dual-crystant antimony catheter. Continuous monitoring was started 1 h prior to the meal (baseline) and lasted 3 h (post-prandial, post-antacid and final periods). The antacid capacity of labelled and unlabelled antacids was similar. The mean percentages of antacids retained in the stomach fitted a linear model. The mean half-emptying time of Talcid was 63.9±27.9 min, while that of Maalox was 57.3±23.9 min (P=NS). The recordings of gastric pH (mean values of pH for each period) showed a similar profile for both antacids. The mean pH (Maalox vs Talcid) was 1.69 vs 2.07 in the baseline period, 1.95 vs 1.93 in the post-prandial period, 1.79 vs 1.15 in the post-antacid period (P=NS) and 0.4 vs 0.52 in the final period (P<0.05 vs prior periods). In conclusion, the gastric emptying of Talcid and Maalox was similar and pH profiles were parallel and remained unchanged for the two antacids within the first hour of intake. A significant decrease in pH was observed 1 h after intake of the antacids, suggesting a possible rebound effect.     

液体试餐核素胃排空显像对糖尿病患者胃排空功能的研究

目的应用放射性核素标记的液体试餐行改良的胃排空显像,选择最佳检查体位及胃排空功能评价指标;进而评估糖尿病患者胃轻瘫发生率,并为其诊断及严重程度分级提供依据。 方法55名健康志愿者（对照组）和100例2型糖尿病患者（试验组）分别口服99Tcm-DTPA液体试餐后,即刻应用SPECT仪同时行平卧前位、平卧后位动态显像。影像采集结束后,勾画胃区ROI,经计算机处理后获得时间-放射性曲线,分别计算平卧前位、平卧后位胃半排空时间（GET_1/2）及30 min胃排空率（GER_30min）。3 d后服用同等量放射性核素液体试餐后行坐立后位胃排空动态显像,数据采集及处理方式同前。在此基础上,进一步对正常对照组及试验组胃排空显像数据进行t检验。 结果正常对照组平卧前位GET_1/2为（12.76±2.22）min,其95%置信区间上限为17.1 min（可作为胃排空功能减退的判断标准）。对照组平卧前位和平卧后位、平卧后位和坐立后位GET_1/2及GER_30min比较,差异均有统计学意义（t=5.35、11.20、-6.37、-9.77,均P < 0.01）;对照组和试验组、试验1组（无消化系统症状糖尿病患者组）和试验2组（有消化系统症状糖尿病患者组）平卧前位GER_30min比较,差异均有统计学意义（t=6.22、3.01,均P < 0.01）,其中试验组平卧前位GER_30min较对照组小,试验2组平卧前位GER_30min较试验1组小。统计试验组GET_1/2,41%胃排空功能减退,其中,9%胃排空功能重度受损。 结论液体试餐核素胃排空显像是一种简单易行、准确可靠的胃排空功能检测方法。GET_1/2和GER_30min可作为胃排空功能减退程度的指标,并优选平卧前位进行检查,可在临床推广应用。     

Altered gastric emptying in patients with irritable bowel syndrome

Irritable bowel syndrome is the most frequent functional disorder of the digestive system. Patients with irritable bowel syndrome have motor disorders not only in the colon, but also in other parts of the digestive tract such as the oesophagus and small intestine; however, it is not known whether the stomach is also involved. We used a radiolabelled mixed solid-liquid meal (technetium-99m for the solid component, indium-111 for the liquid component) to study gastric emptying of solids (GES), liquids (GEL) and indigestible solids (GER) in 50 patients diagnosed as having irritable bowel syndrome (30 with predominant constipation and 20 with predominant diarrhoea). GER was measured by counting the number of indigestible solids remaining in the stomach 4 h after they were swallowed. In patients with irritable bowel syndrome, GES and GEL were slower than in control subjects (P<0.05). GER was normal in all patients except for two women. Thirty-two patients (64%) showed delayed GES, 29 (58%) delayed GEL, and 2 (4%) delayed GER. Among patients with irritable bowel syndrome, GES was slower in those with predominant constipation than in those with predominant diarrhoea (P<0.05); GEL and GER were similar in both groups. Gastroparesis was found in a large proportion of patients with irritable bowel syndrome, suggesting the presence of a more generalised motor disorder of the gut. Received 29 July and in revised form 29 December 1998     

Gastric emptying in patients with chronic liver diseases

There have been a number of reports of gastric emptying in cirrhosis, all with unconfirmed results. Moreover, the mechanism for delayed emptying in cirrhotic patients is unclear. We evaluated gastric emptying in patients with chronic hepatitis and cirrhosis by means of gastric emptying scintigraphy. METHODS: The subjects were 18 normal controls and 75 patients with chronic viral hepatitis (50 patients had chronic hepatitis and 25 patients had cirrhosis). Tc-99m diethyltriamine pentaacetic acid labeled solid meals were used to evaluate gastric emptying; the half-time (T 1/2) of which was calculated. Digestive symptom scores were determined at the time of gastric emptying tests. RESULTS: Fourteen (28%) of 50 patients with chronic hepatitis and 16 (64%) of 25 patients with cirrhosis had delayed gastric emptying. T 1/2 in patients with cirrhosis was significantly higher than that in normal controls and patients with chronic hepatitis (p = 0.0001 and 0.0003, respectively). The difference between T 1/2 in patients with chronic hepatitis and that in normal controls was not significant. On regression analysis, two indices-the serum albumin level and platelet count-were found to be significantly related to delayed gastric emptying. CONCLUSIONS: Gastric emptying was more delayed in cirrhotic patients than in those with chronic hepatitis and normal controls. Delayed gastric emptying may be related to liver function and portal hypertension.     

A simple scintigraphic method for continuous monitoring of gastric emptying

A new and simple scintigraphic method for the measurement of gastric emptying was developed and validated. The test meal consists of 200 g potato mash mixed with 0.5 g Dowex 2X8 particles (mesh 20–50) labelled with 37 MBq (1 mCi) technetium-99m. After ingestion of the meal, sequential dynamic 15-s anteroposterior exposures in the supine position are obtained for 90 min. A second recording sequence of 20 min is added after a 30-min interval. The results can be displayed as immediate cine-replay, as time-activity diagrams and/or as activity retention values. Complicated mathematical fittings are not necessary. The method lends itself equally to the testing of in- and outpatients. Correspondence to: R.W Lipp     

Use of Technegas as a radiopharmaceutical for the measurement of gastric emptying

Many radiopharmaceuticals and test meals that are used to measure gastric emptying are less than optimal. A vegetable-based solid meal, such as rice, labelled with a radiopharmaceutical that also has the capacity to measure gastric emptying of liquids, is likely to be ideal. The role of Technegas as a radioisotopic marker to measure gastric emptying of rice and liquids was evaluated. Technegas-labelled rice was incubated in 0.9% saline, 1 M HCl and simulated gastric fluid (3.2 g/l pepsinogen, pH 2–3) to assess stability of the label. In eight healthy volunteers gastric emptying of two meals – 200 g rice (370 kcal) and 75 g dextrose dissolved in 300 ml water (300 kcal), both labelled with 20 MBq of Technegas – was measured scintigraphically. Over 4 h, the average label stability was 93.7%±0.5% in 0.9% saline, 91.0%±0.4% in 1 M HCl and 93.6%±0.7% in simulated gastric juice. The lag phase was longer for rice than dextrose (25±7 min vs 4±2 min; P<0.05), but there was no difference in the post-lag emptying rate (2.1±0.3 kcal/min vs 1.7±0.2 kcal/min; P=0.2) between the two meals. We conclude that Technegas is a suitable radiopharmaceutical for measurement of gastric emptying of rice and nutrient-containing liquids. Received 8 March and in revised form 19 April 1999     

Comparison of technetium 99m-phytate and technetium 99m-sulphur colloid in primary bone tumours

Eleven patients with proven primary bone tumour (five Ewing sarcomas, six osteosarcomas) and two cases of metastatic bone involvement (primary other than bone) were investigated with^99mTc-phytate and^99mTc-sulphur colloid to compare the behaviour of the two radiopharmaceuticals at the tumour site. After intravenous administration of the respective radiopharmaceutical, imaging of the tumour site and its contralateral part was carried out at 15 min and 1 h intervals. The data were stored in our computer. Bone scanning was also carried out in all patients.^99mTc-phytate uptake was observed at the tumour site in ten cases. The^99mTc-sulphur colloid study revealed sparse or no significant uptake in eight cases. In two patients, with osteosarcoma^99mTc-sulphur colloid investigation showed uptake at the primary tumour site. However, the distribution pattern is different from that of^99mTc-phytate. No significant uptake of either 99mTc-phytate or^99mTc-sulphur colloid was observed in the two patients with metastatic skeletal disease. It may be concluded that the unusual accumulation of^99mTc-phytate at the tumour site is not due to any generalized reticuloendothelial phenomenon and that the radiopharmaceutical itself is responsible for this.     

放射性核素唾液显像的临床应用进展

放射性核素唾液显像是将99Tcm-硫胶体滴入口腔内,形成99Tcm-硫胶体唾液混合物,利用放射性核素显影仪获得唾液流经途径影像,能够无创性探测吞咽引起的肺吸入.临床怀疑吸入性肺炎时,应首选放射性核素唾液显像进行诊断.     

Tc-99m labeled triethelene tetraamine polysterene resin gastric emptying studies in bulimia patients

To evaluate gastric emptying in patients with bulimia, 20 patients (all women, ranging in age from 12 to 49 years) with upper gastrointestinal symptoms ingested 150–200 Ci ^99mTc-triethelene tetraamine polysterene resin in cereal and had scintigraphy in the supine position. Data were accumulated at 5 min intervals to determine the gastric emptying time (GET). The results showed that the gastric emptying time was prolonged in 12 patients and decreased in 8. All 12 patients with prolonged emptying time were given 10 mg metoclopramide intravenously; 9 of these had a good response and 3 had no response. Although all patients had subjective symptoms of gastric dysfunction, the results indicate that about 60% had delayed and 40% had rapid gastric emptying. The findings of two extremes of gastric emptying time remain to be explained, however, this enables (a) objective documentation of gastric emptying as this technique (b) can separate those patients with rapid GET from those with prolonged GET, who might benefit from metoclopramide.Supported in part by BRSG Grant RR # 05374 from the Biochemical Research Support Branch, Division of Research Facilities and Resources, NIH     

Relationship between severity of clinical symptoms and delay in gastric emptying in chronic gastritis; studied with 99mTc-DTPA scintigraphy

The gastric emptying time is studied with ^99mTC-DTPA-labeled mixed meal in 18 patients with chronic gastritis, all confirmed by endoscopic examination and biopsy. Emptying was slow in all such patients, but the intensity of symptomatology showed no correlation with gastric emptying half time.