Original article
Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms

https://doi.org/10.1016/S1542-3565(03)00130-7Get rights and content

Abstract

Background & Aims:

Endoscopy-negative dyspepsia is a common symptom that often is difficult to define in pathophysiologic terms. The aim of this study was to assess the frequency of disordered gastric accommodation and emptying in patients referred with unexplained upper gastrointestinal symptoms.

Methods:

A computerized diagnostic index was used to identify all patients, 18–70 years old, who underwent single-photon emission computed tomography (SPECT) to assess gastric accommodation at Mayo Clinic Rochester over a 3-year period. Demographics, clinical features, and results of diagnostic testing, including scintigraphic gastric emptying, were extracted from the electronic record.

Results:

A total of 214 patients were identified; the primary clinical diagnoses were functional dyspepsia, postfundoplication syndromes, rumination syndrome, and diabetic dyspepsia. Gastric accommodation was impaired in 43% of the whole group: 47% of functional dyspepsia, 44% of postfundoplication syndromes, and 33% of diabetic dyspepsia. Delayed gastric emptying was most prevalent in diabetic dyspepsia, and was accelerated in postfundoplication syndromes groups. Thirty-seven percent of patients had abnormal gastric emptying. The highest prevalence of delayed gastric emptying was in the diabetic dyspepsia and accelerated gastric emptying in postfundoplication syndromes groups. Twenty-five percent of patients with normal gastric emptying had impaired accommodation. Upper-gastrointestinal symptoms were not different in groups based on gastric accommodation or emptying results.

Conclusions:

Impaired gastric accommodation is common in patients with unexplained dyspepsia. Symptoms alone cannot predict physiologic disturbances. These noninvasive tests identify single or combined pathophysiologic disturbances and may help to identify subgroups of patients as candidates for more selective pharmacotherapy in the future.

Section snippets

Study participants

The study was approved by the Mayo Institutional Review Board, and patient authorization for use of the medical records for research purposes was confirmed before access to the medical records was provided. A computerized diagnostic index was used to identify all patients who had a prior negative upper gastrointestinal endoscopy between the ages of 18–70 and subsequently underwent SPECT imaging to assess gastric accommodation at the Mayo Medical Center in Rochester, MN, between September 1999

Patients and subgroups

A total of 214 patients underwent SPECT assessment of gastric accommodation at Mayo Clinic Rochester between September 1999 and July 2002. These patients were categorized into 4 subgroups: (1) patients with upper abdominal symptoms without a prior history of fundoplication, diabetes mellitus, or rumination syndrome categorized as having functional dyspepsia; (2) patients with upper abdominal symptoms postfundoplication; (3) patients with upper abdominal symptoms and a history of diabetes

Discussion

This study evaluated the clinical application of SPECT and scintigraphic imaging to assess gastric accommodation and emptying, respectively, in patients with endoscopy-negative upper abdominal symptoms in a tertiary referral setting. Our aim was to assess whether SPECT and scintigraphy provide clinically useful information beyond what is provided from more standard clinical testing.

The majority (174 of the 214 patients) underwent assessment of both gastric accommodation and gastric emptying,

Acknowledgements

The authors thank Mrs. Cindy Stanislav for excellent secretarial assistance.

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  • Cited by (0)

    Supported in part by grants R01 DK-54681 (to M.C.), K24 DK-02638 (to M.C.), and R01 DK 57982 (to J.A.M.) from the National Institutes of Health.

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