Optimal measurement of gastric emptying of solids in gastroparesis or functional dyspepsia: evidence to establish standard test
Michael Camilleri, Ting Zheng, Kia Vosoughi, Camille Lupianez‐Merly, Deborah J. Eckert, Irene Busciglio, Duane D. Burton, Saam Dilmaghani
Abstract
Objective Symptoms in gastroparesis (Gp) and functional dyspepsia (FD) overlap; using egg protein substitute to measure gastric emptying of solids (GES), ~40% of patients are reclassified from Gp to FD, and vice versa. Our aim was to assess inter-individual and intra-individual coefficients of variation (COV) in GES in symptomatic patients with Gp or FD with documented slow or normal GES, respectively. Design Scintigraphic GES (T 1/2 and GE% at 2 and 4 hours) using a 320 kcal real egg meal (30% fat) was tested in the following: single measurements in 20 patients with diabetes mellitus (10 each type 1 and type 2); repeat GES to estimate COV intra measured: 3 days apart in 9 Gp, 4 weeks apart in 21 Gp and 18 with FD with normal GE assigned to placebo and in 70 patients at 94.3 weeks (median) apart. Results COV inter for GE% at 4 hours and GE T 1/2 were respectively 14.2% and 23.5% in FD and 27.5% and 33% in Gp; COV intra for GE% at 4 hours and GE T 1/2 up to 4 weeks apart were 23.4% and 37.9% in FD and 20.1% and 33% in Gp. GE% at 2 hours showed less consistent results. However, >85% retained original diagnosis as normal or delayed. From clinical GES to baseline research for Gp group, repeat GES (after treatment) showed the COV intra for GE% at 4 hours was 37.3% at median 94.3 weeks, with 26/70 changed diagnoses. Conclusion The 320 kcal (30% fat) GES scintigraphic test provides consistent diagnosis in >85% and should be the standard test for suspected gastric emptying disorders.