Gastric emptying after a new, more physiological anti-obesity operation: the Magenstrasse and Mill procedure

The Magenstrasse and Mill (M&;M) procedure for obesity is designed to preserve normal gastric emptying mechanisms. The hypothesis investigated in this study was that gastric emptying would be normal after the M&;M gastroplasty. Gastric emptying studies were performed using both liquid and solid test meals, in ten morbidly obese patients (MO group) and in 13 patients after the M&;M procedure (MM group). Seven people of normal weight served as controls and were matched for age, sex and height to the M&;M and MO groups. Three years after the M&;M procedure, mean (SD) weight loss was 42 (19) kg, with a mean loss of excess weight of 58% (20%). Gastric emptying half-times (t_1/2) are expressed in minutes, as median values (25th and 75th percentiles). The t_1/2 for solids was 97 (85-110) min in the control group, 140 (86-220) min in the MO group and 79 (46-150) min in the MM group. Median gastric emptying for solids was 0.7% (0.6%-0.8%) per minute in the control group, 0.5% (0.3%-0.8%) in the MO group and 0.9% (0.4%-1.4%) in the M&;M group. There were no statistically significant differences in the emptying times of the three groups. It is concluded that the M&;M procedure achieves acceptable weight loss, while preserving gastric emptying mechanisms and thus minimising possible side-effects such as vomiting, dumping and diarrhoea, which are common complications of gastric bypass procedures.     

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

PURPOSE: To assess the gastric emptying pattern of a standardized solid meal in patients with non-ulcer dyspepsia by using scintigraphic techniques. METHODS: 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. RESULTS: 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. CONCLUSION: 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.     

Effect of proximal vagotomy and Roux-en-Y diversion on gastric emptying kinetics in asymptomatic patients

The role of the distal stomach in gastric emptying was studied. Ten patients with proximal gastric vagotomy (PV) and 10 age-matched patients with Roux-en-Y gastro-jejunostomy (R-Y) were compared with 10 healthy controls. Gastric emptying of solids and liquids was determined by the use of Tc-99m SC scrambled eggs and In-111 DTPA. In PV, gastric emptying of both solids and liquids was delayed; the prolongation with solids was mainly accounted for by an abnormal lag phase. In R-Y patients, no lag phase was observed, and the solid emptying curve pattern was characterized by early rapid emptying followed by very slow emptying. Both the solid and liquid phases were prolonged. The lag phase is affected by proximal vagotomy and is mainly determined by the distal stomach, which appears to be essential for normal emptying.     

Validation of gastric-emptying scintigraphy of solids and liquids in mice using dedicated animal pinhole scintigraphy.

Gastric emptying in small laboratory animals is a useful parameter to assess gastrointestinal motility for physiologic, pharmacologic, or other research purposes. In mice, phenol red recovery is considered the gold standard for determination of gastric emptying. However, this method requires sacrifice of the animal and yields data of gastric emptying at only 1 time point. Gastric-emptying scintigraphy, the gold standard technique in humans, allows sequential and serial measurements in the same subject. In this study, we developed and validated a novel method of gastric-emptying scintigraphy applied in mice, by comparing it with phenol red photospectrometry. METHODS: A dedicated animal pinhole gamma camera was equipped with a specially designed mouse application device. Gastric emptying was measured in unanesthetized mice using pinhole scintigraphy. First, gastric emptying determined with scintigraphy was compared with gastric phenol red recovery simultaneously within the same population. Subsequently, normal values for gastric emptying of solids and liquids in mice were established, and finally, the effects of handling stress and the late effects of frequently used anesthetics or sedatives on gastric emptying were assessed by scintigraphy. RESULTS: Gastric emptying of liquids measured by pinhole scintigraphy did not significantly differ from that measured by phenol red recovery. For the same information, 80% fewer animals were needed for the scintigraphic method. More stress-related delay in gastric emptying was induced by multiple handling of the mice, compared with the less frequent handling that was associated with taking measurements every 10 min or more (P < 0.05). The mean half-emptying time for solids measured by scintigraphy was significantly slower than that for liquid emptying (P < 0.01). Previous anesthesia did not significantly affect gastric emptying 6 h after induction. CONCLUSION: Dedicated small-animal pinhole gastric-emptying scintigraphy is a reliable tool to investigate gastrointestinal motility in mice, significantly reducing the number of laboratory animals needed for statistical power in trials. The technique enables sequential and serial measurement within 1 subject and is thus useful for follow-up investigations, which can be performed even after invasive procedures that require anesthesia.     

Gender-related differences in gastric emptying

This study was undertaken to determine if men and women have similar rates of gastric emptying. Fifteen normal weight male subjects aged 20-53 yr (mean 30 yr) and 15 normal weight female subjects aged 20-45 yr (mean 32 yr) were studied. Each subject ingested an identical 300-g meal consisting of 150 g of beef stew and 150 g of orange juice. Technetium-99m-(99mTc) labeled liver pate was used as the radioactive marker for the solid phase; indium-111 DTPA [( 111In]DTPA) was the liquid marker. A scintillation camera and computer was used to measure the rate of emptying of the solid and liquid phases. Correction for radionuclide depth, decay, and crosstalk was performed. The half-emptying time for men was: solids 59.8 +/- 3.7 min, liquids 30.3 +/- 2.3 min, and for women was: solids 92.4 +/- 7.5 min, liquids 53.8 +/- 4.9 min. These differences were statistically significant (solids, p = 0.00097; liquids, p = 0.00038). We conclude that women empty both solids and liquids from their stomachs more slowly than men. Possible mechanisms for the difference in gastric emptying rates between men and women are discussed.     

Influence of the menstrual cycle and of menopause on the gastric emptying rate of solids in female volunteers

The aim of this study was to assess the influence of the normal menstrual cycle and of menopause on the gastric emptying rate of solids. Gastric emptying was studied in 15 premenopausal and ten postmenopausal women with an isotopic technique after the ingestion of a radiolabelled test meal. Premenopausal women were studied twice: within 1 week prior to menses and again 1 week after onset of menses. Postmenopausal women were studied only once. The emptying curves of the solid component of the meal fitted a linear model. The half-emptying time was 78±5 min during the follicular phase, 75 ± 7 min during the luteal phase and 76 ± 6 min in post-menopausal women (differences not statistically significant). The mean percentages of the meal retained in the stomach at different time intervals were also similar in the three groups. These results suggest that the menstrual cycle does not influence the gastric emptying rate of solids, which remains unchanged in relation to the follicular phase or after menopause. Correspondence to: I. Carrió     

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 before and after transverse gastroplasty for morbid obesity

Twenty-three morbidly obese patients underwent gastric emptying studies (Tc-99m egg salad sandwich--a semisolid meal) preoperatively, and at three months and 12 months postoperatively to evaluate the effect of transverse gastroplasty on gastric emptying and to determine the predictive value of this study for weight loss. At three months pouch emptying was variable with nine of 23 patients having prolonged half-times, and 14 shortened half-times compared with preoperative values, despite both groups having identical weight loss. At 12 months pouch half-times returned to baseline. The data suggests that this type of gastroplasty causes weight loss solely by reducing the gastric volume resulting in reduced meal volume. Weight loss is not related to impaired pouch emptying, which might result in a prolonged feeling of fullness. Gastric emptying studies neither preoperatively nor postoperatively have weight loss predictive value for this particular operation.     

Comparison of gastric emptying scintigraphy based on the geometric mean of the gastric proportion of the abdominal radioactivity or on the geometric mean of the intragastric radioactivity

PURPOSE: Using gastric emptying scintigraphy the gastric retention rate is commonly calculated within a gastric region of interest (intragastric method). This technique may have significant limitations when left oblique anterior views are acquired, due in part to attenuation resulting from intragastric redistribution. To minimize these drawbacks, it was proposed to express the intragastric content as a percentage of the abdominal radioactivity (abdominal method). Our goal was to compare these two methods when anterior-posterior scanning is used. METHODS: Antero-posterior scintigraphic data of 272 consecutive patients were analysed by both methods. Retention rates were obtained by both observation and calculation by power exponential fit. Gastric emptying parameters (half-emptying time of solids (T(50,S)) and liquids (T(50,L)), lag phase (T(lag)) time and real emptying time (T(RE))), and quality of fit were also computed and compared. RESULTS: For solids, the intragastric method resulted in weakly higher experimental retention rates, whereas retention rates were quite similar for liquids. Differences between experimental and calculated retention rates were smaller for abdominal method, for both liquids and solids. As a result, values for the quality of fit were higher for the abdominal method. Significant differences were observed only for calculated T(50,S) (122+/-46 min vs. 124+/-48 min, mean difference 2+/-2 min, P<0.00001) and T(RE) (163+/-64 min vs. 168+/-68 min, mean difference 4.5+/-3.8 min, P<0.05), respectively, for the abdominal and the intragastric methods. However, the Bland-Altman statistical method revealed good agreements (<5% outliers). CONCLUSION: Intragastric and abdominal methods can be used indifferently to treat antero-posterior data of gastric scintigraphy.     

Liquid gastric emptying in the pig: effect of concentration of inhaled isoflurane.

An animal model of gastric emptying may have use in the study of gastric physiology and pharmacoscintigraphy. The pig has anatomy and physiology similar to that of humans. Our aim was to develop a model of gastric emptying in the pig. It was not possible to perform this study in conscious pigs; therefore, an anesthetic model was developed. METHODS: Fifteen studies were performed on 4 pigs (age, 2-6 mo; weight, 20-100 kg). After acclimatization and training, pigs were fasted overnight before the study. Pigs were anesthetized using inhaled isoflurane without the use of injected premedication agents. An orogastric tube was inserted for the administration of a liquid meal, which consisted of (99m)Tc-diethylenetriaminepentaacetic acid either in water (nonnutrient) or with dextrose (nutrient meal). The pig was laterally positioned to enable right lateral dynamic acquisition to be performed. Anesthesia was maintained at 2% +/- 0.5% isoflurane in 4 studies and 0.8% +/- 0.5% in 11 studies (4 nutrient, 7 nonnutrient). RESULTS: With 2% +/- 0.5% isoflurane, there was delayed gastric emptying with a mean 50% emptying time (+/-SEM) of 141 +/- 14 min. With 0.8% +/- 0.5% isoflurane, the liquid meal emptied in an exponential manner similar to that of humans, with mean 50% emptying times (+/-SEM) of 30 +/- 7 min (nutrient) and 31 +/- 4 min (nonnutrient). CONCLUSION: The results indicate that high-dose anesthesia inhibits gastric emptying, but with low-dose anesthesia a useful pig model of liquid gastric emptying can be developed.     

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。     

胃肠激素与功能性消化不良患者胃肠动力障碍的关系

目的　探讨胃肠激素与功能性消化不良 (FD)患者胃肠动力障碍的关系。方法　对 5 4例FD患者进行胃排空检查 ,根据结果将其分为胃排空延缓FD组和胃排空正常FD组 ,另以 17例正常人作为对照组。用放免法测定受试者空腹和餐后血浆NT、MTL、Gas、SS含量。结果　胃排空延缓FD组空腹和餐后血浆NT含量、餐后血浆Gas含量明显高于正常人及胃排空正常FD组 ,空腹和餐后血浆MTL含量则明显低于另外两组 ,而空腹和餐后血浆SS与另外两组比较差异无统计学意义。结论　FD患者胃肠动力障碍与NT、MTL、Gas密切相关 ;NT、MTL、Gas在FD的发病机制中可能有一定作用。     

Delayed gastric emptying in patients with caustic ingestion

INTRODUCTION: Patients with caustic ingestion may develop esophageal and/or gastric cicatrization. OBJECTIVE: Scintigraphic assessment of liquid gastric emptying time in patients with caustic ingestion. MATERIALS AND METHODS: 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. RESULTS: 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). CONCLUSION: Our results show that patients with caustic ingestion have prolonged liquid gastric emptying even in the absence of any gastric symptoms.     

Simultaneous assessment of gastric accommodation and emptying: studies with liquid and solid meals.

The aim of this study was to develop a scintigraphic test to measure gastric emptying and accommodation simultaneously. METHODS: Gastric emptying and accommodation were measured in healthy subjects. To determine gastric accommodation, the stomach was imaged with SPECT 20 min after intravenous administration of 185 MBq (5 mCi) (99m)Tc-pertechnetate. After ingestion of 11 MBq (300 micro Ci) (111)In-diethylenetriaminepentaacertic acid in a liquid nutrient drink or an (111)In-oxine-labeled egg sandwich, dual-isotope imaging assessed SPECT gastric dimensions and gastric emptying every 20 min up to 240 min. Gastric accommodation was calculated as the percentage change in planar (2-dimensional) gastric cross-sectional area (CSA) using a left anterior oblique planar projection and the percentage change in total SPECT gastric voxel counts (3-dimensional) compared with the baseline image. RESULTS: With the liquid nutrient drink (9 subjects), maximal mean CSA (158% +/- 12% of baseline; P < 0.05) occurred 40 min after meal ingestion, when only 69% +/- 3% of the radiolabeled liquid nutrient drink remained in the stomach. At 120 min, mean CSA was 125% +/- 8% of baseline, but only 35% +/- 3% of the liquid nutrient drink remained in the stomach. Using SPECT to measure 3-dimensional volumes, maximal gastric volume occurred 20 min after meal ingestion (189% +/- 25% of baseline). With the solid egg meal (10 subjects), maximal total CSA (159% +/- 13% of baseline) occurred immediately after meal ingestion; total CSA remained significantly increased above baseline for the first 3 h after ingestion of the egg meal, despite only 12% +/- 4% gastric retention at 3 h. Using SPECT to measure 3-dimensional volumes, maximal gastric volume occurred immediately after the meal (184% +/- 19% of baseline). CONCLUSION: This method permits simultaneous measurement of gastric emptying and accommodation. In healthy subjects, the gastric accommodation response is prolonged and persists despite nearly complete emptying of a liquid or solid meal.     

Scintigraphic evaluation of gastric emptying: are radiolabeled solids necessary?

A standard, dual-isotope meal (Tc-99m-egg sandwich and In-111 DTPA in water) was administered to 14 normal volunteers and 37 patients, who had not undergone gastric surgery, to determine if the emptying characteristics of the liquid phase alone could accurately predict delayed solid emptying. Delayed gastric emptying was defined clinically as a solid half-emptying time more than two standard deviations greater than the mean for normal volunteers. Linear regression analysis was performed on the natural logarithm of liquid fractional retention at each time interval to yield a slope and y-intercept for each subject. There was no significant difference (0.6 less than P less than 0.8) between volunteers and patients with normal solid emptying for the liquid slope. In patients who exhibited delayed gastric emptying for solids, the liquid slopes were significantly different from the normal values (P less than .001). There was a high correlation of liquid slope to solid half-emptying time in all patients and volunteers (r = -0.80, P less than .001). Comparison of the liquid slope measurement to solid half-emptying time criteria revealed a sensitivity of 96%, a specificity of 100%, and a predictive value of 100% for the slope test. These results suggest that delayed gastric emptying can be accurately detected with a liquid-solid meal using only a single-liquid label.     

Dynamic antral scintigraphy following solid and liquid meals in healthy human subjects

AIMS: Dynamic antral scintigraphy (DAS), a non-invasive technique for the assessment of post-prandial gastric contractions, has been used to demonstrate abnormal contractility in several clinical conditions. The objective of the present study was to assess differences between solid and liquid meals regarding gastric contractions in healthy volunteers using DAS. METHODS: Ten healthy male volunteers were studied after ingesting solid or liquid meals [approximately 1670 kJ (approximately 400 kcal)] labelled with 99mTc phytate and administered in a random order. Gastric images were acquired for 120 min for gastric emptying half-time (T1/2) measurement. Dynamic (1 frame x s(-1)) images of the gastric antrum were acquired at 30 min intervals for 4 min for the assessment of antral contractility. RESULTS: Gastric emptying T1/2 values for solid and liquid meals were similar (58.1+/-19.06 min vs. 69.4+/-6.76 min; P=0.13). For the solid meal, average values for both frequency (3.08+/-0.15 cycles x min(-1) vs. 2.78+/-0.18 cycles x min(-1); P=0.003) and amplitude (33.94+/-5.2% variation vs. 24.09+/-7.37% variation; P=0.002) of antral contractions were significantly higher than those obtained with the liquid meal. For either of the test meals, none of the antral contractility variables correlated with gastric emptying T1/2. CONCLUSIONS: Dynamic antral scintigraphy is capable of detecting differences between solid and liquid meals concerning post-prandial gastric antral contractions under physiological conditions. The frequency and amplitude of gastric antral contractions after a solid meal are greater than after an exclusively liquid meal of similar calorie content, in spite of lack of a difference regarding gastric emptying.     

Influence of the physiological changes of gastric emptying on the simplified single sample 14 C-urea breath test

The aim of this study was to assess the influence of the physiological changes of gastric emptying on the simplified 14C-urea breath test. Thirty patients performed the test in fasting conditions. Patients were orally administered 0.074 mega Bq of 14C-urea, mixed with 0.0185 mega Bq of 99mTc-S colloids in 25 ml water. A breath sample was taken before and 10 min after intake of the tracers and followed by a 2 min planar anterior scintigraphic image of the abdomen to measure gastric activity. Gastric emptying was estimated by dividing the residual gastric activity at 10 min by the total activity in the abdomen. The procedure was performed twice for each patient after a 24 h interval. The repeatability of both the gastric emptying test and the urea breath test was assessed by the method described by Bland and Altman. The coefficient of repeatability of the urea breath test was 1.18 for a confidence interval of 95%. The coefficient of repeatability of gastric emptying was 27.4. There was no significant correlation (r= 0.08) between the plot of the individual modifications of urea breath test and residual gastric activity in two successive tests. It is concluded that the physiological changes of gastric emptying do not influence the results obtained by the simplified, single-sample 14C-urea breath test.     

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.     

Comparison of left anterior oblique and geometric mean gastric emptying

A left anterior oblique image (LAO) and the geometric mean of anterior and posterior counts have both been proposed as methods for acquiring gastric emptying data. Both approaches are used to correct for the changes in attenuation that occur as the depth of radiolabeled solids changes during gastric emptying. These two methods were compared by using a power exponential curve fit to calculate a lag phase, an equilibrium emptying rate, and a half-time for gastric emptying in 20 patients. There were no significant differences (mean +/- 1 s.e.m.) in the measured half-emptying time (115 +/- 10 versus 104 +/- 7 min) (p = 0.08) or rate of gastric emptying (0.015 +/- 0.002 versus 0.015 +/- 0.002 min-1) (p = 0.56) for LAO imaging versus the geometric mean. However, the LAO measurements of the lag phase were significantly higher (69 +/- 7 min) than the geometric mean (53 +/- 6 min) measurements (p = 0.004). This resulted in 4/20 (20%) of patients with normal geometric mean lag phase measurements who would have been reclassified as abnormal using the LAO method.     

Evaluation of small-bowel transit for solid and liquid test meal in healthy men and women

Evaluation of severe functional gastrointestinal motility disorders requires an investigation of the entire gastrointestinal tract. This should be possible with a single radionuclide imaging study. The purpose of this study was (1) to define normal values of small-bowel transit in men and women and (2) to assess a possible difference between gender or test meal, since it has been shown that women have slower gastric emptying than men, and gastric emptying of solids is slower than liquids. A standard gastric-emptying test for a solid (technetium-99m sulphur colloid, 230 Kcal) and liquid (indium-111 DTPA water) test meal was performed in 12 healthy male and 12 healthy female volunteers. After 135 min, the volunteer was placed in the supine position for static imaging of the abdomen every 15 min for 6 h. Decay and crossover-corrected geometric mean gastric-emptying data were fit to a modified power exponential function to determine the 10% stomach emptying time for solids and liquids separately. An ROI was drawn around the caecum and ascending colon to determine the arrival time of at least 10% of the solid and liquid test meal. Ten percent small-bowel transit time (10% SBTT) and orocaecal transit time (OCTT) were calculated. The OCTT for males and females, respectively for solids and liquids, are 294.6 +/- 18.8; 301.3 +/- 24.5; 294.6 +/- 18.8 and 301.3 +/- 24.5 min. The 10% SBTT for males and females, respectively for solids and liquids, are 280.3 +/- 18.4; 280.6 +/- 24.0; 288.2 +/- 18.9 and 297.4 +/- 24.4 (mean +/- SEM) min. We observed a simultaneous transfer of solids and liquids from the terminal ileum to caecum (correlation coefficient 0.90). There is no statistically significant difference in SBTT between gender or solids and liquids. In contrast to the gastric-emptying time, the SBTT of solids and liquids were not significantly different nor was a gender difference found. Determination of the OCTT seems to be the simplest and most accurate approach to measure SBTT. Since ileocaecal transfer occurs as a bolus phenomenon, a 111In-labelled test meal can also be used for the determination of colon transit in a single imaging study protocol.