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Studio dello Svuotamento Gastrico STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari Dott. Paolo Usai Satta.

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Presentation on theme: "Studio dello Svuotamento Gastrico STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari Dott. Paolo Usai Satta."— Presentation transcript:

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2 Studio dello Svuotamento Gastrico STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari Dott. Paolo Usai Satta Venezia-Mesre, 18 Marzo 2011

3 Disorders of gastric function: Impaired fundic relaxation Abnormal fundic emptying Weak 3 cpm rhythm Dilated gastric antrum Antral hypomotility Gastroparesis Gastric dysrhythmias Small bowel dysmotility

4 GASTRIC EMPTYING PROBLEMS ABSORPTION AND BIO-AVAILABILITY OF DRUGS FOOD ASSUMPTION REGULATION DIGESTION AND ABSORPTION OF NUTRIENTS HORMONAL AND METABOLIC ANSWER Jackson, 2005 THERAPEUTIC EFFECTS

5 Tests to Assess Gastric Emptying Upper gastrointestinal radiographic study Scintigraphy 13 C-Breath tests Paracetamol US for serial changes in antral area Magnetic Resonance Imaging SPECT Smart Pill

6 Tests to Assess Gastric Emptying Upper gastrointestinal radiographic study Scintigraphy 13 C-Breath tests Paracetamol US for serial changes in antral area Magnetic Resonance Imaging SPECT Smart Pill

7 Rao S, NeuroGastroenterol Mot, 2011 Recommended Tests in clinical practice

8 Gastric emptying scintigraphy gold standard 99mTc-sulfur colloid in eggs (solid meal) - Half-empty time (solid meal,60 30min; liquid meal, 30 15min) Gastric outlet obstruction or function obstruction, DM gastroparesis, s/p vagotomy, gastrinoma… Follow up and evaluation of the effectiveness of treatment.

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10 Gastric emptying Breath test 13 C-octanoic acid BT (solid food) 13 C-acetate BT (liquid food)

11 Principle of 13 C-OBT

12 Ghoos et al Gastroenterology 1993 = excellent correlation Choi et al Gastroenterology 1997 = poor correlation OBT vs Scintigraphy Delbende B, Eur J Gastroenterol Hepatol, 2000 From 2000…… = good correlation

13 Intra-individual variability Perri* et al 17% (2010) (2000)(1997)(1993) *Perri F, Dig Liv Dis, 2010

14 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 acid Criticisms concerning OBT metabolism Keller J, NeuroGastroenterol Mot, 2009

15 Kloetzer L, Neuro-Gastroenterol Mot 2010 Wir eless motility capsule Smart Pill -Measures pH, pressure and temperature -Gastric emptying time -Small bowel transit time -Colonic transit time - Whole gut transit time Validated vs scintigraphy Rao S, NeuroGastroenterol Mot, 2011

16 Contraindications: history of gastric bezoar disorders of swallowing suspected strictures, fistulas, or physiological GI obstruction GI surgery within the past three months severe dysphagia to food or pills Crohns disease or diverticulitis a subject who uses an implanted or portable electro-mechanical medical device such as a cardiac pacemaker or infusion pump The SmartPill Capsule is not for use in pediatric populations.

17 Tests to Assess Gastric Emptying What is their clinical significance?

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19 Dyspepsia and gastric emptying Usai Satta P, Eur Rev Med Pharmacol Sci, 2005

20 Stanghellini V., Gastroenterol, 1996 Dyspepsia and Scintigraphy

21 **p< 0.01 Sarnelli G,Gastroenterol 2003 393 pts Dyspepsia and 13C-OBT

22 Usai Satta P, 2005 Other diseases and 13C-OBT Influences on nutritional status and drug efficacy?

23 The association of delayed emptying with specific symptoms is relatively weak Gastric emptying tests do not yield a high diagnostic specificity With few exceptions, most studies have failed to demonstrate a correlation between the severity of delayed emptying and prokinetic therapy An initial treatment approach should be required before performig gastric emptying test In 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 role Tack J, Best Pact Res Clin Gastroenterol, 2009 Clinical impact

24 Conclusions - Several recommended tests to assess gastric emptying are available - The clinical impact of these tests is yet uncertain - A pivotal role may be played in refractary patients and in the impairment of nutritional status

25 Cagliari Pisa Genova Padova Ancona Pescara-Chieti Bari San Giovanni R. Napoli Torino IGGET project (from 2005, ongoing) OBT-Sofar

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