Addition of small‐bowel transit scintigraphy to gastric emptying for assessment of patients with upper gastrointestinal symptoms

Addition of small‐bowel transit scintigraphy to gastric emptying for assessment of patients with upper gastrointestinal symptoms:

Abstract

Background

Dyspeptic symptoms are not well correlated with gastric emptying (GE) results.

Aims

To determine (a) prevalence of delayed SB transit (SBT) in patients undergoing GE scintigraphy for symptoms of gastroparesis; (b) symptoms associated with delayed SBT.

Methods

Patients with symptoms of gastroparesis underwent combined GE and SBT scintigraphy (GES/SBTS). Patients ingested a mixed solid (S)‐liquid (L) meal with egg whites labeled with 500 µCi Tc‐99 m sulfur colloid and water with 125 µCi In‐111 DTPA. Retained S and L gastric activity and percent of L In‐111 activity in terminal ileum (TI) and/or cecum/colon at 6 h were determined. Patient Assessment of Gastrointestinal Symptoms (PAGI‐SYM) assessed symptoms from 0 (none) to 5 (very severe).

Key Results

Of 363 patients, 174 (47.9%) had delayed S GE, 141 (38.8%) delayed L GE, and 70 (19.3%) delayed SBT. Delayed SBT was seen in 24 (6.6%) with normal S GE and 46 (12.7%) with delayed S GE. Patients with isolated delayed SBT had highest symptom scores for postprandial fullness (3.5), stomach fullness (3.4), nausea (3.2), bloating (3.2), compared to isolated delayed S GE who had highest symptom scores for postprandial fullness (3.7), nausea (3.6), stomach fullness (3.4), and early satiety (3.3).

Conclusions & Inferences

Delayed SBT occurred in 19.3% of dyspeptic patients using GES/SBTS. While postprandial and stomach fullness were common to both delayed S GE and delayed SBT, early satiety was associated with delayed S GE whereas bloating was associated with delayed SBT. Thus, SBTS can augment GES to help explain some symptoms associated with dyspepsia and suspected gastroparesis.