Satiety testing: ready for the clinic?

Abstract

Drink tests are advocated as an inexpensive, noninvasive technique to assess gastric function in patients with a variety of upper digestive symptoms. Many patients with dyspeptic complaints will achieve satiation or develop symptoms at ingested volumes below those typically required to achieve these endpoints in controls. Substantial variation in test performance exists and a greater degree of standardization is required. Additionally, it remains unclear exactly what drink tests measure, as correlations with measures of gastric sensation, accommodation and emptying are modest at best. Finally, results of drink tests do not guide therapy. At present, these tests are best reserved for research studies and are not advocated for use in clinical practice.

Figure 1

Symptoms before and after a 5-min water load test in controls and patients with functional dyspepsia. Patients with dyspepsia were significantly more symptomatic in terms of nausea (A), fullness (B), and bloating (C) both at baseline and after the water load test. Symptom scores at all time points were significantly different between the two groups. P1: 10 min after WL5; P2: 20 min after WL5; P3: 30 min after WL5. Data are expressed as mean ± SD. Adapted from Jones et al[2].

Figure 2

Drink test self-efficacy. Controls (A), and patients with either gastroparesis (B) or gastroesophageal reflux disease (C) are able to accurately estimate drinking capacity, while patients with functional dyspeptics (D) cannot. VAS: Visual analog scale. Adapted from Jones et al[2].

Figure 3

Volumes measured by gastric volume scintigraphy for total, proximal and distal stomach volume over time. Patients with functional dyspepsia had higher fasting volumes but reduced maximal tolerated volumes during drink test and reduced lower distal stomach volumes (^aP < 0.05, ^bP < 0.01, ^dP < 0.001; Mann-Whitney U-test). Adapted from van der Elzen et al[10]. HV: Healthy volumes; FD: Functional dyspepsia.

Figure 4

Correlation between nutrient drink test (kcal) and gastric emptying rate (% per min of gastric content) in the dyspeptic patients. Adapted from Cuomo et al[11].