Towards a less costly but accurate test of gastric emptying and small bowel transit

Abstract

Our aim is to develop a less costly but accurate test of stomach emptying and small bowel transit by utilizing selected scintigraphic observations 1-6 hr after ingestion of a radiolabeled solid meal. These selected data were compared with more detailed analyses that require multiple scans and labor-intensive technical support. A logistic discriminant analysis was used to estimate the sensitivity and specificity of selected summaries of scintigraphic transit measurements. We studied 14 patients with motility disorders (eight neuropathic and six myopathic, confirmed by standard gastrointestinal manometry) and 37 healthy subjects. The patient group had abnormal gastric emptying (GE) and small bowel transit time (SBTT). The proportion of radiolabel retained in the stomach from 2 to 4 hr (GE 2 hr, GE 3 hr, GE 4 hr), as well as the proportion filling the colon at 4 and 6 hr (CF 4 hr, CF 6 hr) were individually able to differentiate health from disease (P less than 0.05 for each). From the logistic discriminant model, an estimated sensitivity of 93% resulted in similar specificities for detailed and selected transit parameters for gastric emptying (range: 62-70%). Similarly, combining selected observations, such as GE 4 hr with CF 6 hr, had a specificity of 76%, which was similar to the specificity of combinations of more detailed analyses. Based on the present studies and future confirmation in a larger number of patients, including those with less severe motility disorders, the 2-, 4-, and 6-hr scans with quantitation of proportions of counts in stomach and colon should provide a useful, relatively inexpensive strategy to identify and monitor motility disorders in clinical and epidemiologic studies.