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Radiopharmaceuticals for Diagnostics
Published in Michael Ljungberg, Handbook of Nuclear Medicine and Molecular Imaging for Physicists, 2022
Jim Ballinger, Jacek Koziorowski
Imaging can be used to investigate disorders in transit in various parts of the gastrointestinal system. Rapid dynamic imaging as the patient swallows a small amount of 99mTc-labelled liquid or solid can be used to measure the esophageal transit time, which can be delayed in motility disorders, lower esophageal sphincter dysfunction, scleroderma, spasm, and achalasia. Gastroesophageal reflux with or without pulmonary aspiration can be particularly useful in children. Extension of a gastric emptying study can provide information about small-bowel transit time. However, studies of colon transit cannot be performed with 99mTc due to its half-life being too short; in this case 111In-DTPA is used [25].
The Clinical Application of 5-HT Agonists and Antagonists in Gastrointestinal Disease
Published in T.S. Gaginella, J.J. Galligan, SEROTONIN and GASTROINTESTINAL FUNCTION, 2020
Timothy P. Roarty, Richard W. McCallum
In our own study of 43 gastroparetic patients who had failed previous conventional therapy due to either a lack of an effect or treatment-limiting side effects, cisapride (20 mg t.i.d.) was given in a randomized double-blind, placebo-controlled design over a six-week period.68 There was significant improvement in the percent of solid meal retained in the stomach at 60,90, and 120 minutes. There was also significant improvement in the tl/2 for gastric emptying relative to baseline. Although the changes in gastric emptying in the placebo group did not reach significance, when the cisapride and placebo groups were compared, there was no significant difference in the final gastric emptying study either in percent retention, the tl/2, or on symptoms. The results of our study were likely skewed by the representation of an already refractory, difficult-to-manage referral base population that limited the benefit of cisapride or any medical intervention.
Common gastrointestinal investigations and psychological concerns
Published in Simon R. Knowles, Laurie Keefer, Antonina A. Mikocka-Walus, Psychogastroenterology for Adults, 2019
Diagnostic tests for gastroparesis (very delayed emptying of the stomach) include gastric emptying, C13 breath test, and scintigraphy. For any gastric emptying study, patients need to stop medications such as opioid analgesia, anti-cholinergic, and prokinetic agents that may affect gastric emptying for 48 to 72 hours. It has also been shown that hyperglycaemia and smoking tobacco can delay gastric emptying [24].
Utility of a laboratory score in the prediction of gastric emptying in autoimmune gastritis patients
Published in Acta Clinica Belgica, 2018
Patients with AIG may present with diverse upper gastrointestinal symptoms in the absence of any organic gastric lesion, some with symptoms suggestive of delayed gastric emptying. There is a need of a simple tool to know which patients with AIG have normal or delayed gastric emptying, because AIG is not a rare disease, it is not limited to the elderly population or only to the gastroenterological setting [4]. Global and simple scores may identify which patients with AIG would most likely benefit from a gastric emptying study. Therefore, we hypothesized that the GS and SS scoring systems may be helpful in discerning AIG patients with delayed GE from patients with normal gastric emptying.
Gastroparesis managed with peroral endoscopic pyloromyotomy
Published in Baylor University Medical Center Proceedings, 2020
Jessica S. Clothier, Steven G. Leeds, Ahmed Ebrahim, Marc A. Ward
To date, single-center series have shown encouraging outcomes in follow-up. One cohort of seven patients treated with POP showed clinical improvement and significant decrease in gastric emptying study times in six of seven patients.2 Another study of 30 patients demonstrated POP effectiveness when 47% of patients had complete normalization of gastric emptying postoperatively.6 Finally, the largest series on POP so far demonstrated an average 4-hour gastric emptying study time drop from 37% preoperatively to 20% postoperatively.7
Adult idiopathic hypertrophic pyloric stenosis - a common presentation with an uncommon diagnosis
Published in Journal of Community Hospital Internal Medicine Perspectives, 2018
Syed Moin Hassan, Ateeq Mubarik, Salman Muddassir, Furqan Haq
50-year-old Caucasian female with a past medical history of hypertension came into the emergency department with the chief complaint of abdominal pain. She reported acute onset constant left upper abdominal pain that started two weeks ago, progressively worsened, rated a 10/10 in intensity, non-radiating and described as sharp, burning and stabbing. It was associated with nausea, vomiting, foul-smelling black tarry stools, and anorexia. She reported experiencing chronic abdominal pain, vomiting, and diarrhea since she was 13 years old. She saw 6–8 doctors a month in her youth with most doctors attributing her symptoms to a sensitive stomach or food poisoning. Her first esophagogastroduodenoscopy (EGD) in 2013 showed a hiatal hernia. A repeat EGD was done in April 2017, which, according to the patient, was inconclusive in elucidating a cause of her symptoms. In the current admission, a gastric emptying study was done, which showed delayed gastric emptying. CT abdomen pelvis showed thickening of the distal gastric antrum (Figure 1). On subsequent EGD, 300 ml of residual oatmeal was appreciated in the stomach, and the pylorus demonstrated a ‘cervix sign.’ A stenotic pylorus was found, which was dilated to 15 mm (Figures 2, 3). At this time, our main differential diagnosis included AIHPS, peptic ulcer disease, malignancy, and Gastrointestinal stromal tumors (GISTs). The definitive diagnosis could only be made on the final pathology report. The patient was discharged and had multiple endoscopic dilations over the coming months with minimal relief in symptoms. After discussion with gastroenterology, general surgery, and the patient who wished for a more permanent treatment for her underlying condition, she underwent a distal partial gastrectomy with a Billroth 1 gastroduodenostomy. Pathology was significant for focally hyperplastic gastric muscularis propria. There was no evidence of surface gastric metaplasia or increased numbers of polymorphonuclear leukocytes (Figure 4). After the pathology report, the patient was diagnosed with AIHPS as any evidence of malignancy or GISTs had been ruled out. Postoperatively, the patient had a gradual and slow recovery, and on her 3-month follow-up visit, she reported considerable improvement of her symptoms.