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Studio dello Svuotamento Gastrico

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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Studio dello Svuotamento Gastrico

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  1. Studio dello Svuotamento Gastrico Dott. Paolo Usai Satta STRUTTURA COMPLESSA GASTROENTEROLOGIA, Cagliari Venezia-Mesre, 18 Marzo 2011

  2. Disorders of gastric function: Impaired fundic relaxation Abnormal fundic emptying Weak 3 cpm rhythm Gastric dysrhythmias Dilated gastric antrum Antralhypomotility Gastroparesis Small bowel dysmotility

  3. 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

  4. TeststoAssessGastricEmptying Upper gastrointestinal radiographic study Scintigraphy 13C-Breath tests Paracetamol US for serial changes in antral area Magnetic Resonance Imaging SPECT Smart Pill

  5. TeststoAssessGastricEmptying Upper gastrointestinal radiographic study Scintigraphy 13C-Breath tests Paracetamol US for serial changes in antral area Magnetic Resonance Imaging SPECT Smart Pill

  6. RecommendedTests in clinicalpractice Rao S, NeuroGastroenterol Mot, 2011

  7. 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.

  8. Gastric emptying Breath test 13C-octanoic acid BT (solid food) 13C-acetate BT (liquid food)

  9. Principle of 13C-OBT

  10. 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

  11. Intra-individual variability Perri* et al 17% (2010) (1993) (1997) (2000) *Perri F, Dig Liv Dis, 2010

  12. 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

  13. 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

  14. TeststoAssessGastricEmptying What is their clinical significance?

  15. Dyspepsia and gastric emptying Usai Satta P, Eur RevMedPharmacol Sci, 2005

  16. Dyspepsia and Scintigraphy Stanghellini V., Gastroenterol, 1996

  17. Dyspepsia and 13C-OBT 393 pts **p< 0.01 Sarnelli G,Gastroenterol 2003

  18. Other diseases and 13C-OBT Usai Satta P, 2005 Influences on nutritional status and drug efficacy?

  19. 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

  20. 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

  21. Genova Padova Ancona Pisa Pescara-Chieti Cagliari Bari San Giovanni R. • IGGET project (from 2005, ongoing) Torino Napoli OBT-Sofar

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