Abstract
Background
Gastric emptying scintigraphy (GES) of solids is typically used to evaluate for gastroparesis.
Aims
The purpose of this study was to determine the value of simultaneously measuring gastric emptying of liquids and solids for assessing patients for delayed gastric emptying.
Methods
A total of 596 patients at our institution from September 2007 to January 2010 underwent GES with assessment of both solid and liquid gastric emptying. An EggBeaters® with jam sandwich meal radiolabeled with Tc-99 m was used for solid GES and water radiolabeled with In-111 for liquid GES.
Results
Inclusion criteria (no medications affecting gastric motility in 48 h prior to test; no prior gastric surgery) was met by 449 patients. Liquid gastric emptying was significantly correlated to solid gastric emptying: 30 min (r = 0.652, P < 0.001), 60 min (r = 0.624, P < 0.001) and 120 min (r = 0.766, P < 0.001). Interestingly, 60 patients, of which 57 were nondiabetic, had normal solid GES but delayed liquid emptying and represented 26% of the 228 patients with normal solid GES. Gastric retention of solids was mildly correlated with nausea, vomiting, loss of appetite, early satiety and feeling excessively full after meals. Gastric emptying of liquids was associated with early satiety and loss of appetite.
Conclusions
Gastric emptying of liquids correlates well with gastric emptying of solids. When evaluating patients for gastroparesis, assessment of gastric emptying of liquids in addition to solids may help identify additional patients with delayed gastric emptying, particularly non-diabetic patients where 26% with normal solid emptying may have delayed emptying of liquids. Symptoms of gastroparesis, however, are primarily associated with delayed gastric emptying of solids.
Similar content being viewed by others
References
Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–1622.
Stanghellini V, Tosetti C, Paternico A, et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology. 1996;110:1036–1042.
Sarnelli G, Caenepeel P, Geypens B, et al. Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia. Am J Gastroenterol. 2003;98:783–788.
Jones KL, Russo A, Stevens JE, et al. Predictors of delayed gastric emptying in diabetes. Diabetes Care. 2001;24:1264–1269.
Horowitz M, Harding PE, Maddox AF, et al. Gastric and oesophageal emptying in insulin-dependent diabetes mellitus. J Gastroenterol Hepatol. 1986;1:97–113.
Soykan I, Sarosiek I, McCallum RW. The effect of chronic oral domperidone therapy on gastrointestinal symptoms, gastric emptying, and quality of life in patients with gastroparesis. Am J Gastroenterol. 1997;92:976–980.
Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008;103:753–763.
Couturier O, Bodet-Milin C, Querellou S, et al. Gastric scintigraphy with a liquid-solid radiolabelled meal: performances of solid and liquid parameters. Nucl Med Commun. 2004;25:1143–1150.
Chaudhuri TK, Fink S. Gastric emptying in human disease states. Am J Gastroenterol. 1991;86:533–538.
Kelly K. Gastric emptying of liquids and solids: roles of proximal and distal stomach. Am J Physiol. 1980;239:G71–G76.
Siegel JA, Urbain JL, Adler LP, et al. Biphasic nature of gastric emptying. Gut. 1988;29:85–89.
Ziessman HA, Okolo PI, Mullin GE, Chander A. Liquid gastric emptying is often abnormal when solid emptying is normal. J Clin Gastroenterol. 2009;43:639–643.
Ziessman HA, Chander A, Clarke JO, Ramos A, Wahl RL. The added diagnostic value of liquid gastric emptying compared with solid emptying alone. J Nucl Med. 2009;50:726–731.
Bonapace ES, Maurer AH, Davidoff S, et al. Whole gut transit scintigraphy in the clinical evaluation of patients with upper and lower gastrointestinal symptoms. Am J Gastroenterol. 2000;95:2838–2847.
Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low-fat meal: Establishment of international control values. Am J Gastroenterol. 2000;95:1456–1462.
Miller MA, Parkman HP, Brown KL, et al. Comparison of scintigraphy and lactulose breath hydrogen test for assessment of orocecal transit: lactulose accelerates small bowel transit. Dig Dis Sci. 1997;42:10–18.
Bromer MQ, Kantor SB, Knight LC, et al. Assessment of colonic transit in patients with idiopathic constipation (IC): comparison of colon transit scintigraphy (CTS) and radioopaque markers (ROM). Am J Gastroenterol. 2001;96:S145.
Rentz AM, Kahrilas P, Stanghellini V, et al. Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders. Qual Life Res. 2004;13:1737–1749.
Revicki DA, Rentz AM, Dubois D, et al. Development and validation of a patient-assessed gastroparesis symptom severity measure: The Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther. 2003;18:141–150.
Arts J, Caenepeel P, Verbeke K, Tack J. Influence of erythromycin on gastric emptying and meal related symptoms in functional dyspepsia with delayed gastric emptying. Gut. 2005;54:455–460.
Khayyam U, Sachdeva P, Gomez J, et al. Assessment of symptoms during gastric emptying scintigraphy to correlate symptoms to delayed gastric emptying. Neurogastroenterol Motil. 2010;22:539–545.
Wright RA, Thompson D, Syed I. Simultaneous markers for fluid and solid gastric emptying: New variations on an old theme. J Nucl Med. 1981;22:772–776.
Fisher RS, Malmud LS, Bandid P, et al. Gastric emptying of a physiologic mixed solid-liquid meal. Clin Nucl Med. 1982;7:215–221.
Siegel JA, Krevsky B, Maurer AH, et al. Scintigraphic evaluation of gastric emptying: Are radiolabeled solids necessary? Clin Nucl Med. 1989;14:40–46.
Ziessman HA, Fahey FH, Collen MJ. Biphasic solid and liquid gastric emptying in normal controls and diabetics using continuous acquisition in LAO view. Dig Dis Sci. 1992;37:744–750.
Horowitz M, Maddox AF, Wishart JM, Harding PE, Chatterton BE, Shearman DJ. Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med. 1991;18:229–234.
Lin HC, Prather C, Fisher RS, et al. Measurement of gastrointestinal transit. Dig Dis Sci. 2005;50:989–1004.
Wang YR, Fisher RS, Parkman HP. Trends of gastroparesis-related hospitalizations in the United States, 1995–2004. Am J Gastroenterol. 2008;103:313–322.
Szarka LA, Camilleri M, Vella A, et al. A stable isotope breath test with a standard meal for abnormal gastric emptying of solids in the clinic and in research. Clin Gastroenterol Hepatol. 2008;6:635–643.
Kuo B, McCallum RW, Koch K, et al. Comparison of gastric emptying of a non-digestible capsule to a radiolabeled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2008;27:186–196.
Cassilly D, Kantor S, Knight L, Maurer A, Fisher RS, Parkman HP. Gastric emptying of a nondigestible solid: Assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil. 2008;20:311–319.
Cassilly DW, Wang YW, Friedenberg FK, Nelson DB, Maurer AH, Parkman HP. Symptoms of gastroparesis. Use of the gastroparesis cardinal symptom index in patients referred for gastric emptying scintigraphy. Digestion. 2008;78:144–151.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Sachdeva, P., Malhotra, N., Pathikonda, M. et al. Gastric Emptying of Solids and Liquids for Evaluation for Gastroparesis. Dig Dis Sci 56, 1138–1146 (2011). https://doi.org/10.1007/s10620-011-1635-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10620-011-1635-9