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Diagnostic Evaluation of Gastroparesis

  • Michael ClineEmail author
  • Carol Rouphael
Chapter

Abstract

Gastroparesis is suspected in patients with postprandial abdominal pain, nausea, vomiting, or bloating, once peptic ulcer disease and gastric outlet obstruction are ruled out endoscopically. Multiple tests are available for the diagnosis of gastroparesis and include gastric emptying scintigraphy (GES), stable isotope breath test, wireless motility capsule, antroduodenal manometry, and other imaging modalities such as ultrasonography and magnetic resonance imaging (MRI). While GES is the gold standard, each of those tests provides different advantages and limitations to their use clinically. GES entails the ingestion of a radiolabeled solid meal and measuring the percentage of radioactivity remaining in the stomach at 0, 1, 2, and 4 hours after meal ingestion. It is considered delayed if there is >60% retention at 2 hours and/or >10% retention at 4 hours. Stable isotope breath test is commonly used and relies on the conversion of an ingested 13C-labeled substrate to 13CO2, which is exhaled from the lungs and measured by breath tests at 30 minutes intervals. It requires healthy subjects for proper absorption and metabolization of 13C labeled to 13CO2. The wireless motility capsule, approved by the US Food and Drug Administration to evaluate for gastric and bowel transit times in patients with suspected slow transit constipation, has the major advantage of assessing extragastric motility which can alter management options. Ultrasonography and magnetic resonance imaging are mostly used in research settings as they require significant skills and expertise.

Keywords

Gastroparesis Gastric emptying scintigraphy Stable isotope breath test Wireless motility capsule Antroduodenal manometry Strengths Limitations 

Abbreviations

C

Carbon

CO2

Carbon dioxide

FDA

Food and Drug Administration

GES

Gastric emptying scintigraphy

MRI

Magnetic resonance imaging

WMC

Wireless motility capsule

References

  1. 1.
    Griffith GH, Owen GM, Kirkman S, Shields R. Measurement of rate of gastric emptying using chromium-51. Lancet. 1966;1(7449):1244–5.CrossRefGoogle Scholar
  2. 2.
    Parkman HP, Harris AD, Krevsky B, Urbain JL, Maurer AH, Fisher RS. Gastroduodenal motility and dysmotility: an update on techniques available for evaluation. Am J Gastroenterol. 1995;90(6):869–92.PubMedGoogle Scholar
  3. 3.
    Kim DY, Myung SJ, Camilleri M. Novel testing of human gastric motor and sensory functions: rationale, methods, and potential applications in clinical practice. Am J Gastroenterol. 2000;95(12):3365–73.CrossRefGoogle Scholar
  4. 4.
    Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127(5):1592–622.CrossRefGoogle Scholar
  5. 5.
    Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, 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(3):753–63.CrossRefGoogle Scholar
  6. 6.
    Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95(6):1456–62.CrossRefGoogle Scholar
  7. 7.
    Tang DM, Friedenberg FK. Gastroparesis: approach, diagnostic evaluation, and management. Dis Mon. 2011;57(2):74–101.CrossRefGoogle Scholar
  8. 8.
    Camilleri M, Hasler WL, Parkman HP, Quigley EM, Soffer E. Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology. 1998;115(3):747–62.CrossRefGoogle Scholar
  9. 9.
    Thomforde GM, Camilleri M, Phillips SF, Forstrom LA. Evaluation of an inexpensive screening scintigraphic test of gastric emptying. J Nucl Med. 1995;36(1):93–6.PubMedGoogle Scholar
  10. 10.
    Guo JP, Maurer AH, Fisher RS, Parkman HP. Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis. Dig Dis Sci. 2001;46(1):24–9.CrossRefGoogle Scholar
  11. 11.
    Ziessman HA, Bonta DV, Goetze S, Ravich WJ. Experience with a simplified, standardized 4-hour gastric-emptying protocol. J Nucl Med. 2007;48(4):568–72.CrossRefGoogle Scholar
  12. 12.
    Desai A, O’Connor M, Neja B, Delaney K, Camilleri M, Zinsmeister AR, et al. Reproducibility of gastric emptying assessed with scintigraphy in patients with upper GI symptoms. Neurogastroenterol Motil. 2018;30(10):e13365.CrossRefGoogle Scholar
  13. 13.
    Camilleri M, Chedid V, Ford AC, Haruma K, Horowitz M, Jones KL, et al. Gastroparesis. Nat Rev Dis Primers. 2018;4(1):41.CrossRefGoogle Scholar
  14. 14.
    Ciferri O. Spirulina, the edible microorganism. Microbiol Rev. 1983;47(4):551–78.PubMedPubMedCentralGoogle Scholar
  15. 15.
    Ghoos YF, Maes BD, Geypens BJ, Mys G, Hiele MI, Rutgeerts PJ, et al. Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology. 1993;104(6):1640–7.CrossRefGoogle Scholar
  16. 16.
    Clegg ME, Shafat A. Procedures in the 13C octanoic acid breath test for measurement of gastric emptying: analysis using Bland-Altman methods. Scand J Gastroenterol. 2010;45(7–8):852–61.CrossRefGoogle Scholar
  17. 17.
    Maes BD, Geypens BJ, Ghoos YF, Hiele MI, Rutgeerts PJ. 13C-Octanoic acid breath test for gastric emptying rate of solids. Gastroenterology. 1998;114(4):856–9.CrossRefGoogle Scholar
  18. 18.
    Choi MG, Camilleri M, Burton DD, Zinsmeister AR, Forstrom LA, Nair KS. Reproducibility and simplification of 13C-octanoic acid breath test for gastric emptying of solids. Am J Gastroenterol. 1998;93(1):92–8.CrossRefGoogle Scholar
  19. 19.
    Shin AS, Camilleri M. Diagnostic assessment of diabetic gastroparesis. Diabetes. 2013;62(8):2667–73.CrossRefGoogle Scholar
  20. 20.
    van de Casteele M, Luypaerts A, Geypens B, Fevery J, Ghoos Y, Nevens F. Oxidative breakdown of octanoic acid is maintained in patients with cirrhosis despite advanced disease. Neurogastroenterol Motil. 2003;15(2):113–20.CrossRefGoogle Scholar
  21. 21.
    Perri F, Bellini M, Portincasa P, Parodi A, Bonazzi P, Marzio L, et al. (13)C-octanoic acid breath test (OBT) with a new test meal (EXPIROGer): toward standardization for testing gastric emptying of solids. Dig Liver Dis. 2010;42(8):549–53.CrossRefGoogle Scholar
  22. 22.
    Pasricha PJ, Parkman HP. Gastroparesis: definitions and diagnosis. Gastroenterol Clin N Am. 2015;44:1):1–7.Google Scholar
  23. 23.
    Rao SS, Camilleri M, Hasler WL, Maurer AH, Parkman HP, Saad R, et al. Evaluation of gastrointestinal transit in clinical practice: position paper of the American and European Neurogastroenterology and Motility Societies. Neurogastroenterol Motil. 2011;23(1):8–23.CrossRefGoogle Scholar
  24. 24.
    Saad RJ, Hasler WL. A technical review and clinical assessment of the wireless motility capsule. Gastroenterol Hepatol (N Y). 2011;7(12):795–804.Google Scholar
  25. 25.
    Kloetzer L, Chey WD, McCallum RW, Koch KL, Wo JM, Sitrin M, et al. Motility of the antroduodenum in healthy and gastroparetics characterized by wireless motility capsule. Neurogastroenterol Motil. 2010;22(5):527–33, e117.PubMedGoogle Scholar
  26. 26.
    Rouphael C, Arora Z, Thota PN, Lopez R, Santisi J, Funk C, et al. Role of wireless motility capsule in the assessment and management of gastrointestinal dysmotility in patients with diabetes mellitus. Neurogastroenterol Motil. 2017;29(9):e13087.CrossRefGoogle Scholar
  27. 27.
    Kuo B, Maneerattanaporn M, Lee AA, Baker JR, Wiener SM, Chey WD, et al. Generalized transit delay on wireless motility capsule testing in patients with clinical suspicion of gastroparesis, small intestinal dysmotility, or slow transit constipation. Dig Dis Sci. 2011;56(10):2928–38.CrossRefGoogle Scholar
  28. 28.
    Arora Z, Parungao JM, Lopez R, Heinlein C, Santisi J, Birgisson S. Clinical utility of wireless motility capsule in patients with suspected multiregional gastrointestinal dysmotility. Dig Dis Sci. 2015;60(5):1350–7.CrossRefGoogle Scholar
  29. 29.
    Sarosiek I, Selover KH, Katz LA, Semler JR, Wilding GE, Lackner JM, et al. The assessment of regional gut transit times in healthy controls and patients with gastroparesis using wireless motility technology. Aliment Pharmacol Ther. 2010;31(2):313–22.PubMedGoogle Scholar
  30. 30.
    Kuo B, McCallum RW, Koch KL, Sitrin MD, Wo JM, Chey WD, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2008;27(2):186–96.CrossRefGoogle Scholar
  31. 31.
    Hasler WL, May KP, Wilson LA, Van Natta M, Parkman HP, Pasricha PJ, et al. Relating gastric scintigraphy and symptoms to motility capsule transit and pressure findings in suspected gastroparesis. Neurogastroenterol Motil. 2018;30(2):e13196.CrossRefGoogle Scholar
  32. 32.
    Soffer E, Thongsawat S. Clinical value of duodenojejunal manometry. Its usefulness in diagnosis and management of patients with gastrointestinal symptoms. Dig Dis Sci. 1996;41(5):859–63.CrossRefGoogle Scholar
  33. 33.
    Fraser RJ, Horowitz M, Maddox AF, Dent J. Postprandial antropyloroduodenal motility and gastric emptying in gastroparesis--effects of cisapride. Gut. 1994;35(2):172–8.CrossRefGoogle Scholar
  34. 34.
    Patcharatrakul T, Gonlachanvit S. Technique of functional and motility test: how to perform antroduodenal manometry. J Neurogastroenterol Motil. 2013;19(3):395–404.CrossRefGoogle Scholar
  35. 35.
    Quigley EM, Donovan JP, Lane MJ, Gallagher TF. Antroduodenal manometry. Usefulness and limitations as an outpatient study. Dig Dis Sci. 1992;37(1):20–8.CrossRefGoogle Scholar
  36. 36.
    Hausken T, Odegaard S, Matre K, Berstad A. Antroduodenal motility and movements of luminal contents studied by duplex sonography. Gastroenterology. 1992;102(5):1583–90.CrossRefGoogle Scholar
  37. 37.
    Schwizer W, Maecke H, Fried M. Measurement of gastric emptying by magnetic resonance imaging in humans. Gastroenterology. 1992;103(2):369–76.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Gastroenterology and HepatologyCleveland Clinic FoundationClevelandUSA

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