Browse the corpus

This activity describes the use of gastric emptying scintigraphy in the evaluation of gastric motility and related disorders. It discusses its role in the assessment of patients with symptoms of gastroparesis or abnormal gastric emptying and discusses the potential use of this procedure to improve patient care. Proper patient preparation and exam technique are reviewed as well as interpretation criteria. The activity highlights the study and its use by a diverse specialty of providers in managing patients with dyspepsia. Objectives: Review the anatomical structures pertinent to gastric emptying and their individual roles. Outline the preparation and examination technique used in gastric emptying scintigraphy. Describe the indications and contraindications to gastric emptying scintigraphy. Summarize interprofessional team strategies for improving care coordination and communication to advance the assessment of gastric motility disorders and improve outcomes. Access free multiple choice questions on this topic.

The first use of nuclear medicine to evaluate gastric motility was performed in 1966 by Dr. Griffith and colleagues of Cardiff, Wales, using a breakfast meal labeled with Chromium-51.[1] By measuring the amount of radioactivity in the stomach (gastric counts) at various time points, they could directly determine the volume of a meal remaining in the stomach and thus determine the rate of gastric emptying (GE). Since then, the modern version of the exam, known as gastric emptying scintigraphy (GES) has become a common diagnostic tool in the assessment of patients with various functional gastrointestinal disorders. Other tests used to measure GE include breath testing and wireless pH capsules. Breath testing is performed using a standardized meal including Spirulina labeled with Carbon-13. The meal passes through the stomach, into the duodenum where it is absorbed, metabolized in the liver and exhaled by the lungs where it is measured. As transit of the meal through the stomach is the rate-limiting step in the process, the test serves as an indirect measurement of GE, assuming normal bowel, liver, and pulmonary function. The wireless pH capsule test is performed by administering a capsule in conjunction with a nutrient bar. The capsule is monitored by a belt worn by the patient and transit from the stomach to small bowel is detected by a sudden increase in pH, denoting transition from the acidic stomach to the alkaline duodenum. Given its noninvasive nature and physiologic methodology compared to these other tests, scintigraphy has become the prevailing means by which to measure gastric emptying (GE).

Factors that may affect the performance and negatively influence the clinical validity of a GES are: Incomplete meal consumption Slow meal consumption (taking longer than 10 minutes) Vomiting a portion of the meal Poor glycemic control If these problems occur, they should be included in the exam report as well as a comment as to their potential impact on the accuracy of the results.

Disorders of gastric emptying often present with the symptoms of dyspepsia, post-prandial pain, bloating, early satiety, nausea, and vomiting. Such non-specific symptoms are frequently encountered by primary care providers, emergency department providers, surgeons, and gastroenterologists. The list of possible etiologies is extensive and includes gastric disorders, biliary disease, intestinal diseases, metabolic disorders, vascular pathology, and psychiatric diagnoses. Even after a thorough clinical history, physical exam and laboratory assessment, the definitive cause often remains in doubt. As such, subspecialty referrals are often sought, leading to these patients being evaluated by surgeons suspecting chronic cholecystitis, gastroenterologists concerned for peptic ulcer disease, vascular surgeons suspecting mesenteric ischemia, and mental health providers assessing for depression or anxiety. Of benefit to all these primary and subspecialty providers and their challenging patients is the well performed gastric emptying scintigraphy (GES) study following consensus guidelines. It provides a validated and reproducible means to accurately identify patients with gastroparesis or rapid gastric emptying as a potential source of their clinical complaints.