Selected Interventions in Nuclear Medicine: Gastrointestinal Motor Functions

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The measurement of gastrointestinal functions by the use of scintigraphy is established in clinical practice and research. The most commonly used test is the gastric-emptying test, which is acknowledged as the gold standard to measure gastric motility and is conducted according to a consensus statement from the national nuclear medicine and motility societies. Other techniques are somewhat more esoteric (eg, measurement of gastric accommodation with single-photon emission computed tomography) or the scintigraphic approach is not the acknowledged gold standard (eg, colonic transit, rectoanal angle, and emptying, esophageal transit). The performance characteristics of many of the scintigraphic measurements have been published and the pros and cons established in the literature. Pharmacologic interventions may also be used during scintigraphy to aid in diagnosis and treatment. Gastrointestinal scintigraphy is an integral and important component of the assessment of gastrointestinal function.

Section snippets

Scintigraphy Relative to Current Gold Standard

Dysphagia is a common esophageal complaint. Barium swallow, upper endoscopy, and/or computed tomography (CT) usually are performed as first-line evaluations to exclude structural abnormalities. If no anatomical abnormality is identified, esophageal manometry is used next7 and is considered the gold standard for the evaluation of dysphagia,8 with defined criteria for achalasia, diffuse esophageal spasms, and nutcracker esophagus. Esophageal manometry can also characterize the function of the

Scintigraphy Relative to Current Gold Standard

Scintigraphy is the gold standard measurement of gastric emptying. Patients with gastric dysmotility disorders may present with a wide array of symptoms from nausea and vomiting to early satiety and abdominal bloating of varying severity.26 Alterations in gastric emptying (accelerated or delayed-gastroparesis) and in accommodation or relaxation of the fundus can lead to similar symptoms and significant patient morbidity.27 Gastric motility disorders continue to pose a challenge to

Scintigraphy Relative to Current Gold Standard

Impaired relaxation (accommodation) to a meal has been proposed as a mechanism to explain postprandial symptoms in 40% of dyspeptic patients.52 Physiologically, accommodation allows the stomach to increase volume without an increase in pressure. Gastric barostat studies have been used classically in research settings to evaluate accommodation, and the barostat is regarded as the gold standard. Barostat measurements are limited by their invasive nature53 and the potential artifact induced by the

Small Bowel Transit

There are 2 approaches to measure small bowel transit: a substrate-breath hydrogen test and scintigraphy. Small bowel transit is difficult to quantify and, thus far, scintigraphy has yielded the most reliable results.67 Transit through the small bowel can be impeded by slow colonic transit. Symptoms attributable to disorders of the small bowel may mimic those of derangements in gastric emptying. This may make it difficult to know whether to check for small bowel transit. Colonic filling at 6

Scintigraphy Relative to Current Gold Standard

Constipation is a common complaint in gastroenterology and primary care visits. Office visits for constipation have increased in the last decade, and the cumulative incidence of constipation is up to 17.6%.72, 73 Differentiating between the types of constipation (irritable bowel syndrome [IBS], slow transit, rectal outlet obstruction) is important in management of constipation. Transit studies using radiopaque markers and serial abdominal radiographs are used most commonly in clinical practice.

Scintigraphy Relative to Current Gold Standard

The gold standard for assessing pelvic floor and rectoanal dynamics during defecation in patients with rectal evacuation problems or anal incontinence is probably barium defecography. However, it has been significantly challenged by magnetic resonance defecography. Dynamic imaging and the use of open magnets that allow for studies in the seated position provide detailed information about structure and integration with function. For example, magnetic resonance imaging helps to identify different

Drug Pharmacodynamics Investigated by Scintigraphy of the GI Tract

Scintigraphy of the GI tract has wide clinical application and has helped in demonstrating the efficacy of treatments or medications. GI and colonic transit provide the most robust and consistent results of the effect of medications that affect GI transit time, such as in patients with IBS. These include alosetron91, 92; tegaserod93; renzapride94, 95; the guanylate cyclase-C agonist, linaclotide96; and the probiotic combination, VSL#3.97 Regional or total colonic transit is correlated

Conclusion

The use of scintigraphy to measure gastrointestinal transit is an important tool for the clinician in the diagnosis and treatment of common gastrointestinal diseases. Studies such as colonic transit and SPECT for measuring gastric accommodation are gaining wider acceptance and availability; however, others such as rectoanal angle and emptying and esophageal scintigraphy are not widely available or lack standardization of the techniques and/or interpretation of the results. Small bowel

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    Funded in part by grants RO1 DK 67071 and K24 DK 02638 from the National Institutes of Health (to M.C.).

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