Management of Gastroparesis
Management of Gastroparesis
Clinical manifestations of gastroparesis warrant a thorough medical history and physical examination. In addition, a number of diagnostic tests may be used to appropriately diagnose this condition including scintigraphy, radiography, breath testing, and antroduodenal manometry.
The gold standard for diagnosis of gastroparesis is gastric emptying scintigraphy of a solid meal. This test is performed up to 4 hours post ingestion of a radiolabeled meal in order to adequately detect delayed gastric emptying by measuring the volume of stomach contents and stomach relaxation.
The upper GI barium series is another method for measuring delayed or poor gastric emptying of barium, gastric dilation, and/or the presence of retained food or bezoar. When little or no emptying of the barium occurs at 30 minutes and retention of gastric barium is noted at 6 hours, gastroparesis is most probable. In some cases (mainly research or study related), breath testing using a nonradioactive isotope bound to solid food may be performed to determine and measure gastric emptying. Antroduodenal manometry may also be utilized to measure motor function, coordination, and relaxation of the stomach and duodenum during fasting and/or postprandial periods. This method can also help to distinguish between neuropathic and myopathic disorders, in addition to aiding in the diagnosis of small bowel obstruction or rumination syndrome.
Other methods that are not as frequently used but may be useful in the diagnosis of gastroparesis include electrogastrography, ultrasonography, MRI, single-photon emission computed tomography (SPECT), and satiety testing. An emerging diagnostic tool is the SmartPill, a wireless capsule monitoring system for the GI tract. In this outpatient procedure, a nondigestible capsule travels throughout the GI tract over 3 to 6 hours and records variables such as pH, temperature, and pressure changes. This information is transmitted to a receiver, which determines gastric emptying time, as well as how well food or liquids pass through the intestines. The capsule is ultimately eliminated in the stool within 24 to 72 hours after administration.
Diagnosis
Clinical manifestations of gastroparesis warrant a thorough medical history and physical examination. In addition, a number of diagnostic tests may be used to appropriately diagnose this condition including scintigraphy, radiography, breath testing, and antroduodenal manometry.
The gold standard for diagnosis of gastroparesis is gastric emptying scintigraphy of a solid meal. This test is performed up to 4 hours post ingestion of a radiolabeled meal in order to adequately detect delayed gastric emptying by measuring the volume of stomach contents and stomach relaxation.
The upper GI barium series is another method for measuring delayed or poor gastric emptying of barium, gastric dilation, and/or the presence of retained food or bezoar. When little or no emptying of the barium occurs at 30 minutes and retention of gastric barium is noted at 6 hours, gastroparesis is most probable. In some cases (mainly research or study related), breath testing using a nonradioactive isotope bound to solid food may be performed to determine and measure gastric emptying. Antroduodenal manometry may also be utilized to measure motor function, coordination, and relaxation of the stomach and duodenum during fasting and/or postprandial periods. This method can also help to distinguish between neuropathic and myopathic disorders, in addition to aiding in the diagnosis of small bowel obstruction or rumination syndrome.
Other methods that are not as frequently used but may be useful in the diagnosis of gastroparesis include electrogastrography, ultrasonography, MRI, single-photon emission computed tomography (SPECT), and satiety testing. An emerging diagnostic tool is the SmartPill, a wireless capsule monitoring system for the GI tract. In this outpatient procedure, a nondigestible capsule travels throughout the GI tract over 3 to 6 hours and records variables such as pH, temperature, and pressure changes. This information is transmitted to a receiver, which determines gastric emptying time, as well as how well food or liquids pass through the intestines. The capsule is ultimately eliminated in the stool within 24 to 72 hours after administration.
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