Prokinetic therapy: What can be measured by gastric scintigraphy?

Evidence suggests that distinct mechanisms underlie diabetic and idiopathic gastroparesis. Differences in gastric acid in gastroparesis of different etiologies and varying degrees of gastric stasis are uninvestigated. We tested the hypotheses that 1) gastric pH profiles show differential alteration in diabetic vs. idiopathic gastroparesis and 2) abnormal pH profiles relate to the severity of gastric stasis. Sixty-four healthy control subjects and 44 gastroparesis patients (20 diabetic, 24 idiopathic) swallowed wireless transmitting capsules and then consumed99mTc-sulfur colloid-labeled meals for gastric scintigraphy. Gastric pH from the capsule was recorded every 5 s. Basal pH was higher in diabetic (3.64 ± 0.41) vs. control subjects (1.90 ± 0.18) and idiopathic subjects (2.41 ± 0.42; P < 0.05). Meals evoked initial pH increases that were greater in diabetic (4.98 ± 0.32) than idiopathic patients (3.89 ± 0.39; P = 0.03) but not control subjects (4.48 ± 0.14). pH nadirs prior to gastric capsule evacuation were higher in diabetic patients (1.50 ± 0.23) than control subjects (0.58 ± 0.11; P = 0.003). Four-hour gastric retention was similar in diabetic (18.3 ± 0.5%) and idiopathic (19.4 ± 0.5%) patients but higher than control subjects (2.2 ± 0.5%; P < 0.001). Compared with control subjects, those with moderate-severe stasis (>20% retention at 4 h) had higher basal (3.91 ± 0.55) and nadir pH (2.23 ± 0.42) values ( P < 0.05). In subgroup analyses, both diabetic and idiopathic patients with moderate-severe gastroparesis exhibited increased pH parameters vs. those with mild gastroparesis. In conclusion, diabetic patients with gastroparesis exhibit reduced gastric acid, an effect more pronounced in those with severely delayed gastric emptying. Idiopathic gastroparetic subjects exhibit nearly normal acid profiles, although those with severely delayed emptying show reduced acid vs. those with mild delays. Thus both etiology and degree of gastric stasis determine gastric acidity in gastroparesis.

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Impact of methodical guidelines of gastric scintigraphy on patients’ radiation exposure

Gastroenterologie a hepatologie ◽

10.48095/ccgh2021159 ◽

2021 ◽

Vol 75 (2) ◽

pp. 159-164

Author(s):

Martina Horváthová ◽

Zuzana Bárdyová ◽

Darina Budošová ◽

Rastislav Husťak

Keyword(s):

Gastric Emptying ◽

Radiation Exposure ◽

Gold Standard ◽

Retrospective Cohort ◽

Noninvasive Method ◽

Lower Intensity ◽

Medicine Department ◽

Nuclear Medicine Department ◽

Gastric Emptying Scintigraphy ◽

Gastric Scintigraphy

Introduction: Gastric emptying scintigraphy (GES) is a safe, noninvasive method for assessing the ability of the stomach to empty which has been used clinically for many years. It is considered as a “gold standard” to assess gastric emptying of both solids and liquids allowing assessment of early, mid and late emptying, each of which may be altered by pathology. The aim of the study was to analyse standard diagnostic approach and evaluate patients` radiation exposure, who underwent GES in Slovakia. Methods: A retrospective cohort study included 55 patients from 2 departments of nuclear medicine (department A, B). Patients’ radiation exposure was determined by dosimetry program IDAC-Dose2.1. The radiopharmaceutical 99mTc-DTPA, always with the same activity, was applied orally to patients at Department B. The applied activity of the radiopharmaceutical at GES was 185 MBq. The radiopharmaceutical 99mTc MAA, with various activity, was applied orally to patients at Department A. Results: According to ICRP60, the eff ective dose (ED) of every patient undergoing GES was 0.77 mSv and, according to ICRP103, the dose was 0.836 mSv at Department B. Patients at Department A were exposed to ionizing radiation with 5-times lower intensity, compared with patients at Department B. It was caused by radiopharmaceutical activity correction. The ED medians according to ICRP60, and according to ICRP103 were 0.167 mSv (range 0.105–0.208 mSv) and 0.181 mSv (range 0.113–0.226 mSv) at Department A, respectively. Discussion: Adequate correction of applied radiopharmaceutical activity is an essential part of GES guidelines and in accordance with ALARA principles. For the accuracy of GES examination, it is necessary to follow a standard 4-hour protocol and an approach which ensures full-featured utilization of the examination while decreasing patient`s radiation exposure. Conclusion: The results of our study show relatively low ED associated with GES, but also confi rm that the GES methodology significantly affects the patient`s radiation exposure

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