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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. - PowerPoint PPT Presentation
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Studio dello Svuotamento Gastrico
STRUTTURA COMPLESSA GASTROENTEROLOGIA, CagliariSTRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari
Dott. Paolo Usai Satta
Venezia-Mesre, 18 Marzo 2011
Disorders of gastric function:
Impaired fundic relaxationImpaired fundic relaxation
Abnormal fundic emptyingAbnormal fundic emptying
Weak 3 cpm rhythmWeak 3 cpm rhythm
Dilated gastric antrumDilated gastric antrum
Antral hypomotilityAntral hypomotility
GastroparesisGastroparesis
Gastric dysrhythmiasGastric dysrhythmias
Small bowelSmall bowel
dysmotilitydysmotility
GASTRIC EMPTYING
PROBLEMS
ABSORPTION
AND
BIO-AVAILABILITY
OF DRUGS
FOOD ASSUMPTION
REGULATION
DIGESTION
AND ABSORPTION
OF NUTRIENTSHORMONAL AND
METABOLIC ANSWER
Jackson, 2005
THERAPEUTIC
EFFECTS
Tests to Assess Gastric Tests to Assess Gastric EmptyingEmptying
Upper gastrointestinal radiographic study
Scintigraphy13C-Breath tests
Paracetamol
US for serial changes in antral area
Magnetic Resonance Imaging
SPECT
Smart Pill
Tests to Assess Gastric Tests to Assess Gastric EmptyingEmptying
Upper gastrointestinal radiographic study
Scintigraphy13C-Breath tests
Paracetamol
US for serial changes in antral area
Magnetic Resonance Imaging
SPECT
Smart Pill
Rao S, NeuroGastroenterol Mot, 2011
Recommended Tests in clinical Recommended Tests in clinical practicepractice
Gastric emptying scintigraphygold 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.
Gastric emptying Breath test
1313C-octanoic acid BT C-octanoic acid BT (solid food)(solid food)13C-acetate BT (liquid food)
Gastric emptying 13C-octanoic acid in egg yolk Passage through pylorus
Intestinal absorption 13C-octanoic acid in duodenal lumen Passage through portal vein system
Liver oxidation 13CO2 production in mitochondria Plasmatic bicarbonate pool
Breath excretion 13CO2
Principle of 13C-OBT
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
t 1/2b Ghoos et al
Choi et al.
Delbende et al.
CV intra (SDd/(mean*1.41) 20% 12% 15%
CV inter (SD/mean) 30% 20% 24%
Intra-individual variability
Perri*
et al
17%(201
0)
(2000)(1997)(1993)
*Perri F, Dig Liv Dis, 2010
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
Kloetzer L, Neuro-Gastroenterol Mot 2010
Wireless motility capsuleSmart 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
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.
Tests to Assess Gastric Tests to Assess Gastric EmptyingEmptying
What is their clinical significance?
Dyspepsia and gastric emptying
Usai Satta P, Eur Rev Med Pharmacol Sci, 2005
Stanghellini V., Gastroenterol, 1996
Dyspepsia and Scintigraphy
**p< 0.01
Sarnelli G,Gastroenterol 2003
393 pts
Dyspepsia and 13C-OBT
Usai Satta P, 2005
Other diseases and 13C-OBT
Influences on nutritional status and drug efficacy?
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
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
Cagliari
Pisa
GenovaGenova Padova
Ancona
Pescara-Chieti
Bari
San Giovanni R.San Giovanni R.Napoli
Torino
IGGET project (from 2005, ongoing)
OBT-Sofar