8Gastric emptying scintigraphy gold standard99mTc-sulfur colloid in eggs (solid meal) -Half-empty time (solid meal,60土30min;liquid meal, 30土15min)Gastric outlet obstruction or function obstruction, DM gastroparesis, s/p vagotomy, gastrinoma…Follow up and evaluation of the effectiveness of treatment.
12OBT vs ScintigraphyGhoos et al Gastroenterology 1993 = excellent correlationChoi et al Gastroenterology 1997 = poor correlationFrom 2000…… = good correlationDelbende B, Eur J Gastroenterol Hepatol, 2000
13Intra-individual variability Perri*et al17%(2010)(1993)(1997)(2000)*Perri F, Dig Liv Dis, 2010
14Criticisms concerning OBT metabolism In a large patient cohort (1279) cumulative 4h-13CO2-excretion is only marginally influenced by patient characteristics and diseases with theoretical impact on absorption and/or postabsorptive metabolism of 13C-octanoic acidKeller J, NeuroGastroenterol Mot, 2009
15Wireless motility capsule Smart Pill-Measures pH, pressure and temperature-Gastric emptying time-Small bowel transit time-Colonic transit time- Whole gut transit timeValidated vs scintigraphyRao S, NeuroGastroenterol Mot, 2011Kloetzer L, Neuro-Gastroenterol Mot 2010
16Contraindications: history of gastric bezoar disorders of swallowing suspected strictures, fistulas, or physiological GI obstructionGI surgery within the past three monthssevere dysphagia to food or pillsCrohns disease or diverticulitisa subject who uses an implanted or portable electro-mechanical medical device such as a cardiac pacemaker or infusion pumpThe SmartPill Capsule is not for use in pediatric populations.
17What is their clinical significance? Tests to Assess Gastric EmptyingWhat is their clinical significance?
19Dyspepsia and gastric emptying Usai Satta P, Eur Rev Med Pharmacol Sci, 2005
20Dyspepsia and Scintigraphy Stanghellini V., Gastroenterol, 1996
21Sarnelli G,Gastroenterol 2003 Dyspepsia and 13C-OBT393 pts**p< 0.01Sarnelli G,Gastroenterol 2003
22Other diseases and 13C-OBT Usai Satta P, 2005Influences on nutritional status and drug efficacy?
23Clinical impactThe association of delayed emptying with specific symptoms is relatively weakGastric emptying tests do not yield a high diagnostic specificityWith few exceptions, most studies have failed to demonstrate a correlation between the severity of delayed emptying and prokinetic therapyAn initial treatment approach should be required before performig gastric emptying testIn refractory patients or in those with symptoms that impair nutritional status or the ability to function normally, assessment of gastric emptying may play a pivotal roleTack J, Best Pact Res Clin Gastroenterol, 2009
24ConclusionsSeveral recommended tests to assess gastric emptying are availableThe clinical impact of these tests is yet uncertainA pivotal role may be played in refractary patients and in the impairment of nutritional status