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Digestive Diseases and Sciences

, Volume 37, Issue 5, pp 744–750 | Cite as

Biphasic solid and liquid gastric emptying in normal controls and diabetics using continuous acquisition in LAO view

  • Harvey A. Ziessman
  • Frederic H. Fahey
  • Martin J. Collen
Original Articles

Abstract

The purpose of this study was to investigate the various phases of gastric emptying using a dual-isotope liquid-solid meal ([99mTc]Sc egg sandwich and [111In]DPTA in water) and continuous acquisition in the left anterior oblique view. The study groups consisted of 10 normal controls and 20 diabetics with symptoms suggestive of diabetic gastroparesis. Solid-phase emptying in both groups almost always had a lag phase followed by linear emptying. Liquid-phase emptying was biexponential in 4/10 normals and 12/20 diabetics, with a short early rapid emptying rate (meanT1/2=48 min in normals and 79 min in diabetics). Solid emptying was delayed in 10, normal in eight, and rapid in two diabetics. Liquid emptying was delayed in 9/10 diabetics who had delayed solid emptying. Diabetics as a group had a significantly delayed solid lag phase (P<0.025), rate of emptying (P<0.05) and percent emptying at 90 min (P<0.025) compared to normal controls. Diabetic liquid emptying was also significantly delayed (P<0.025). The second component of liquid emptying strongly correlated with the solid rate of emptying (r=0.826 in normals and 0.855 in diabetics). Continuous acquisition of gastric emptying studies in the LAO view has allowed us to better define the various phases of solid and liquid gastric emptying.

Key Words

gastrointestinal tract stomach radionuclide studies diabetes mellitus complications 

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References

  1. 1.
    Meyer JH, Ohashi H, Jehn D, Thomson JB: Size of liver particles emptied from the human stomach. Gastroenterology 80:1489–1496, 1981Google Scholar
  2. 2.
    Collins PJ, Horowitz M, Cook DJ, Harding PE, Shearman DJC: Gastric emptying in normal subjects—a reproducible technique using a single scintillation camera and computer system. Gut 24:1117–1125, 1983Google Scholar
  3. 3.
    Loo FD, Palmer DW, Soergel KH, Kalbfleisch JH, Wood CM, et al: Gastric emptying in patients with diabetes mellitus. Gastroenterology 86:485–494, 1984Google Scholar
  4. 4.
    Weiner K, Graham LS, Reedy T, Elashoff J, Meyer JH: Simultaneous gastric emptying of two solid foods. Gastroenterology 81:257–266, 1981Google Scholar
  5. 5.
    Moore JG, Christian PE, Taylor AT, Alazraki N: Gastric emptying measurements: Delayed and complex emptying patterns without appropriate correction. J Nucl Med 26:1206–1210, 1985Google Scholar
  6. 6.
    Horowitz M, Collins PJ, Cook DJ, Harding PE, Shearman DJC: Abnormalities of gastric emptying in obese patients. Int J Obes 7:415–421, 1983Google Scholar
  7. 7.
    Malmud LS, Fisher RS, Knight LC, Rock E: Scinigraphic evaluation of gastric emptying. Sem Nucl Med 12:116–125, 1982Google Scholar
  8. 8.
    Moore JG, Christian PE, Coleman RE: Gastric emptying of varying meal weight and composition in man. Dig Dis Sci 26:16–22, 1981Google Scholar
  9. 9.
    Siegel JA, Krevsky B, Maurer AH, et al: Scintigraphic evaluation of gastric emptying: are radiolabeled solids necessary? Clin Nucl Med 14:40–46, 1989Google Scholar
  10. 10.
    Christian PE, Moore JG, Sorenson JA, Coleman RE, Welch DM: Effects of meal size and correction technique on gastric emptying time: Studies with two tracers and opposed detectors. J Nucl Med 21:883–885, 1980Google Scholar
  11. 11.
    Meyer JW, Van Deventer G, Graham LS, et al: Errors and corrections with scintigraphic measurement of gastric emptying of solid foods. J Nucl Med 24:197–203, 1983Google Scholar
  12. 12.
    Tothill P, McLoughlin GP, Heading RC: Techniques and errors in scintigraphic measurements of gastric emptying. J Nucl Med 19:256–261, 1978Google Scholar
  13. 13.
    Fahey FH, Ziessman HA, Collen MJ, Eggli DF: Left anterior oblique projection and peak-to-scatter ratio for attenuation compensation of gastric emptying studies. J Nucl Med 30:233–239, 1989Google Scholar
  14. 14.
    Collins PJ, Horowitz MB, Shearman DJC, Chatterton BE: Correction for tissue attenuation in radionuclide gastric emptying studies: A comparison of a lateral image method and a geometric mean method. Br J Radiol 57:689–695, 1984Google Scholar
  15. 15.
    Jian R, Vigneron N, Najean Y, Bernier JJ: Gastric emptying and intragastric distribution of lipids in man. Dig Dis Sci 27:705–711, 1982Google Scholar
  16. 16.
    Moore JG, Tweedy C, Christian PE, Datz FL: Effect of age of gastric emptying of liquid-solid meals in man. Dig Dis Sci 28:340–344, 1983Google Scholar
  17. 17.
    Collins PJ, Horowitz M, Chatterton BE: Attenuation correction and lag period in gastric emptying studies. J Nucl Med 27:867–868, 1986 (letter)Google Scholar
  18. 18.
    Datz FL, Christian PE, Moore JG: Confirmation of short solid food lag phase with continuous monitoring of gastric emptying. J Nucl Med 28:563, 1987 (abstract)Google Scholar
  19. 19.
    Heading RC, Tothill P, McLoughlin GP, Shearman DJC: Gastric emptying role measurement in man. A double isotope scanning technique for simultaneous study of liquid and solid components of a meal. Gastroenterology 71:45–50, 1976Google Scholar
  20. 20.
    Hunt JN, Spurrell WR: The pattern of emptying of the human stomach. J Physiol 113:157–168, 1951Google Scholar
  21. 21.
    Siegel JA, Urbain J-L, Adler LP, et al: Biphasic nature of gastric emptying. Gut 29:85–89, 1988Google Scholar
  22. 22.
    Meyer JH: Motility of the stomach and gastroduodenal junction.In Physiology of the Gastrointestinal Tract, 2nd ed. LR Johnson. (ed). New York, Raven Press, 1987, pp 613–629Google Scholar
  23. 23.
    Wooton RL, Meriwether TW: Diabetic gastric atony: A clinical study. JAMA 176:1082, 1981Google Scholar
  24. 24.
    Feldman M, Smith HJ, Simon TR: Gastric emptying of solid radiopaque markers: Studies in healthy subjects and diabetic patients. Gastroenterology 87:895–902, 1984Google Scholar
  25. 25.
    Snape WJ, Battle WM, Schwartz SS, Braunstein SN, et al: Metoclopramide to treat gastroparesis due to diabetes mellitus. Ann Intern Med 96:444–447, 1982Google Scholar
  26. 26.
    Buysschaert M, Moulart M, Urbain JL, et al: Impaired gastric emptying in diabetic patients with cardiac autonomic neuropathy. Diabetes Care 10:448–452, 1987Google Scholar
  27. 27.
    Horowitz M, Harding PE, Chatterton BE, Collins PJ, Shearman DJC: Acute and chronic effects of domperidone on gastric emptying in diabetic autonomic neuropathy. Dig Dis Sci 30:1–9, 1985Google Scholar
  28. 28.
    Schade RR, Dugas MC, Lhotsky GM, Gavaler JS, Van Thiel DH: Effect of metoclopramide on gastric liquid emptying in patients with diabetic gastroparesis. Dig Dis Sci 30:10–15, 1985Google Scholar
  29. 29.
    Keshavarzian A, Iber FL, Vaeth J: Gastric emptying in patients with insulin-requiring diabetes mellitus. Am J Gastroenterol 82:29–35, 1987Google Scholar

Copyright information

© Plenum Publishing Corporation 1992

Authors and Affiliations

  • Harvey A. Ziessman
    • 1
    • 2
  • Frederic H. Fahey
    • 1
    • 2
  • Martin J. Collen
    • 1
    • 2
  1. 1.Division of Nuclear Medicine, Department of RadiologyGeorgetown University HospitalWashington, D.C.
  2. 2.Division of Gastroenterology, Department of MedicineGeorgetown University HospitalWashington, D.C.

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