From the Guidelines
Investigations for gastric paresis should begin with a thorough clinical assessment, followed by a gastric emptying study (scintigraphy) which is the gold standard test, as recommended by the most recent study 1. The initial evaluation should include upper endoscopy to rule out mechanical obstruction. The gastric emptying study typically involves consuming a radioactive-labeled meal with images taken over 4 hours; delayed emptying of >10% of the meal remaining at 4 hours confirms gastroparesis, as supported by 1. Additional useful tests include:
- Wireless motility capsule testing, which measures pH, pressure, and temperature throughout the GI tract
- Antroduodenal manometry to assess gastric and small intestinal contractions
- Blood tests to check for underlying causes like diabetes (HbA1c), thyroid dysfunction, and electrolyte abnormalities
- Testing for viral antibodies for patients with suspected post-viral gastroparesis
- Autonomic function testing when autonomic neuropathy is suspected, as mentioned in 1. These investigations help establish the diagnosis, determine the severity of gastroparesis, identify the underlying cause, and guide appropriate treatment strategies for symptom management, in line with the recommendations from 1. It is essential to verify the appropriate methodology of the gastric emptying study to ensure an accurate diagnosis of delayed gastric emptying, as emphasized in 1. By following this approach, clinicians can provide optimal care for patients with gastroparesis, focusing on improving morbidity, mortality, and quality of life outcomes.
From the Research
Investigations for Gastric Paresis
- Gastric emptying scintigraphy (GES) is a diagnostic tool used to diagnose gastroparesis, as it measures the rate of gastric emptying 2, 3, 4.
- Wireless motility capsules (WMCs) can also be used to evaluate upper gastrointestinal symptoms in suspected gastroparesis, and can provide additional information on lower gut symptoms 3.
- The diagnosis of gastroparesis requires documented delay in gastric emptying, with an optimal test such as scintigraphy or stable isotope gastric emptying breath test, in the absence of mechanical obstruction 5, 6.
- Other diagnostic procedures, such as (13)C-octanoate breath testing, can also be used to evaluate gastroparesis 4.
Gastric Emptying Scintigraphy
- GES is considered the gold standard for diagnosing gastroparesis, as it provides a direct measurement of gastric emptying 2, 3, 4.
- The test involves eating a meal containing a small amount of radioactive material, which is then tracked as it moves through the stomach and small intestine 2.
- The results of GES can be used to determine the severity of gastroparesis and to monitor the effectiveness of treatment 2, 3.
Wireless Motility Capsules
- WMCs are a relatively new diagnostic tool that can be used to evaluate gastrointestinal motility and transit 3.
- The test involves swallowing a small capsule that contains a sensor and a transmitter, which tracks the movement of the capsule through the gastrointestinal tract 3.
- WMCs can provide additional information on lower gut symptoms and can be used to evaluate the effectiveness of treatment 3.