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 Gastric dysrhythmias Dilated gastric antrum Antral hypomotility Gastroparesis Small bowel dysmotility

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

Tests to Assess Gastric Emptying Upper gastrointestinal radiographic study Scintigraphy 13C-Breath tests Paracetamol US for serial changes in antral area Magnetic Resonance Imaging SPECT Smart Pill

Tests to Assess Gastric Emptying Upper gastrointestinal radiographic study Scintigraphy 13C-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 practice Rao S, NeuroGastroenterol Mot, 2011

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.

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

Principle of 13C-OBT

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

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

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

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

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.

What is their clinical significance? Tests to Assess Gastric Emptying What is their clinical significance?

Dyspepsia and gastric emptying Usai Satta P, Eur Rev Med Pharmacol Sci, 2005

Dyspepsia and Scintigraphy Stanghellini V., Gastroenterol, 1996

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

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

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

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

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