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

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

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

5. Tests to Assess Gastric Emptying
Upper gastrointestinal radiographic study
Scintigraphy
13C-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
13C-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
Rao S, NeuroGastroenterol Mot, 2011

8. Gastric emptying scintigraphy
gold standard
99mTc-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.

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

11. Principle of 13C-OBT

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

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

14. Criticisms 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 acid
Keller J, NeuroGastroenterol Mot, 2009

15. Wireless 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
Kloetzer L, Neuro-Gastroenterol Mot 2010

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

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

20. Dyspepsia and Scintigraphy Stanghellini V., Gastroenterol, 1996

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

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

23. Clinical impact
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

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