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Studio dello Svuotamento Gastrico. Dott. Paolo Usai Satta. STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari. Venezia-Mesre, 18 Marzo 2011. Disorders of gastric function:. Impaired fundic relaxation Abnormal fundic emptying. Weak 3 cpm rhythm.

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slide2

Studio dello

Svuotamento Gastrico

Dott. Paolo Usai Satta

STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari

Venezia-Mesre, 18 Marzo 2011

slide3

Disorders of gastric function:

Impaired fundic relaxation

Abnormal fundic emptying

Weak 3 cpm rhythm

Gastric dysrhythmias

Dilated gastric antrum

Antralhypomotility

Gastroparesis

Small bowel

dysmotility

slide4

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

slide5

TeststoAssessGastricEmptying

Upper gastrointestinal radiographic study

Scintigraphy

13C-Breath tests

Paracetamol

US for serial changes in antral area

Magnetic Resonance Imaging

SPECT

Smart Pill

slide6

TeststoAssessGastricEmptying

Upper gastrointestinal radiographic study

Scintigraphy

13C-Breath tests

Paracetamol

US for serial changes in antral area

Magnetic Resonance Imaging

SPECT

Smart Pill

slide7

RecommendedTests in clinicalpractice

Rao S, NeuroGastroenterol Mot, 2011

slide8

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.
slide10

Gastric emptying Breath test

13C-octanoic acid BT (solid food)

13C-acetate BT (liquid food)

slide12

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

slide13

Intra-individual variability

Perri*

et al

17%

(2010)

(1993)

(1997)

(2000)

*Perri F, Dig Liv Dis, 2010

slide14

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

slide15

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

slide17

TeststoAssessGastricEmptying

What is their clinical significance?

slide19

Dyspepsia and gastric emptying

Usai Satta P, Eur RevMedPharmacol Sci, 2005

slide20

Dyspepsia and Scintigraphy

Stanghellini V., Gastroenterol, 1996

slide21

Dyspepsia and 13C-OBT

393 pts

**p< 0.01

Sarnelli G,Gastroenterol 2003

slide22

Other diseases and 13C-OBT

Usai Satta P, 2005

Influences on nutritional status and drug efficacy?

slide23

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

slide24

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
slide25

Genova

Padova

Ancona

Pisa

Pescara-Chieti

Cagliari

Bari

San Giovanni R.

  • IGGET project (from 2005, ongoing)

Torino

Napoli

OBT-Sofar

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