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KEY FACTS
Terminology
Imaging
Diagnostic Checklist
TERMINOLOGY
Definitions
- Normal gastric physiology
- Normal capacity of stomach varies (0.25-1.7 L)
- Solid emptying mostly due to peristaltic pump
- Active contractile waves and pyloric opening
- Solid curve analysis
- Phase 1 (lag phase): Retained in gastric fundus, transported to antrum where diluted, ground (~ 60 min post ingestion)
- Phase 2: Antropyloric wave-like contractions dilute, empty into duodenum
- Liquid emptying mostly due to pressure pump
- Global tonic stomach contractions and pyloric opening
- Liquid curve analysis
- Empties directly into duodenum, no lag phase
- Depends on differential pressures between stomach and small bowel and pyloric opening (pressure pump)
- Delayed gastric emptying (slow gastric motility)
- Symptoms: Nausea, vomiting, early satiety, bloating, abdominal pain
- Common causes: Diabetes mellitus, medications (opioids, allergy, hypertension meds), postsurgical
- Rapid gastric transit (abnormally fast gastric motility)
- Early symptoms begin 15-30 min after meal
- Symptoms: Nausea, vomiting, bloating, cramping, diarrhea, dizziness, fatigue
- Due to food in stomach moving to duodenum too quickly
- Late symptoms begin 1-3 hours after meal
- Symptoms: Weakness, sweating, dizziness
- Due to large glucose load moving into small intestine too quickly with resulting insulin response leading to symptoms
- Common causes: GI surgery, vagal nerve damage, functional dyspepsia (disorder of sensation/movement in upper GI tract)
- Early symptoms begin 15-30 min after meal
- Normal gastric physiology
IMAGING
General Features
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Kwatra NS et al: Gastric emptying of milk in infants and children up to 5 years of age: normative data and influencing factors. Pediatr Radiol. 50(5):689-97, 2020
- Maurer AH et al: Appropriate use criteria for gastrointestinal transit scintigraphy. J Nucl Med. 61(3):11N-17N, 2020
- Cooper CJ et al: Rapid or normal gastric emptying as new supportive criteria for diagnosing cyclic vomiting syndrome in adults. Med Sci Monit. 20:1491-5, 2014
- Sachdeva P et al: Use of a high caloric liquid meal as an alternative to a solid meal for gastric emptying scintigraphy. Dig Dis Sci. 58(7):2001-6, 2013
- Shin AS et al: Diagnostic assessment of diabetic gastroparesis. Diabetes. 62(8):2667-73, 2013
- Ziessman HA et al: The added diagnostic value of liquid gastric emptying compared with solid emptying alone. J Nucl Med. 50(5):726-31, 2009
- Couturier O et al: Gastric scintigraphy with a liquid-solid radiolabelled meal: performances of solid and liquid parameters. Nucl Med Commun. 25(11):1143-50, 2004
- Heyman S: Gastric emptying in children. J Nucl Med. 39(5):865-9, 1998
- SMMI Procedure Guideline for Adult Solid-Meal Gastric-Emptying Study 2009
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References
Tables
Tables
KEY FACTS
Terminology
Imaging
Diagnostic Checklist
TERMINOLOGY
Definitions
- Normal gastric physiology
- Normal capacity of stomach varies (0.25-1.7 L)
- Solid emptying mostly due to peristaltic pump
- Active contractile waves and pyloric opening
- Solid curve analysis
- Phase 1 (lag phase): Retained in gastric fundus, transported to antrum where diluted, ground (~ 60 min post ingestion)
- Phase 2: Antropyloric wave-like contractions dilute, empty into duodenum
- Liquid emptying mostly due to pressure pump
- Global tonic stomach contractions and pyloric opening
- Liquid curve analysis
- Empties directly into duodenum, no lag phase
- Depends on differential pressures between stomach and small bowel and pyloric opening (pressure pump)
- Delayed gastric emptying (slow gastric motility)
- Symptoms: Nausea, vomiting, early satiety, bloating, abdominal pain
- Common causes: Diabetes mellitus, medications (opioids, allergy, hypertension meds), postsurgical
- Rapid gastric transit (abnormally fast gastric motility)
- Early symptoms begin 15-30 min after meal
- Symptoms: Nausea, vomiting, bloating, cramping, diarrhea, dizziness, fatigue
- Due to food in stomach moving to duodenum too quickly
- Late symptoms begin 1-3 hours after meal
- Symptoms: Weakness, sweating, dizziness
- Due to large glucose load moving into small intestine too quickly with resulting insulin response leading to symptoms
- Common causes: GI surgery, vagal nerve damage, functional dyspepsia (disorder of sensation/movement in upper GI tract)
- Early symptoms begin 15-30 min after meal
- Normal gastric physiology
IMAGING
General Features
Imaging Recommendations
DIFFERENTIAL DIAGNOSIS
PATHOLOGY
General Features
CLINICAL ISSUES
Treatment
DIAGNOSTIC CHECKLIST
Consider
Image Interpretation Pearls
Selected References
- Kwatra NS et al: Gastric emptying of milk in infants and children up to 5 years of age: normative data and influencing factors. Pediatr Radiol. 50(5):689-97, 2020
- Maurer AH et al: Appropriate use criteria for gastrointestinal transit scintigraphy. J Nucl Med. 61(3):11N-17N, 2020
- Cooper CJ et al: Rapid or normal gastric emptying as new supportive criteria for diagnosing cyclic vomiting syndrome in adults. Med Sci Monit. 20:1491-5, 2014
- Sachdeva P et al: Use of a high caloric liquid meal as an alternative to a solid meal for gastric emptying scintigraphy. Dig Dis Sci. 58(7):2001-6, 2013
- Shin AS et al: Diagnostic assessment of diabetic gastroparesis. Diabetes. 62(8):2667-73, 2013
- Ziessman HA et al: The added diagnostic value of liquid gastric emptying compared with solid emptying alone. J Nucl Med. 50(5):726-31, 2009
- Couturier O et al: Gastric scintigraphy with a liquid-solid radiolabelled meal: performances of solid and liquid parameters. Nucl Med Commun. 25(11):1143-50, 2004
- Heyman S: Gastric emptying in children. J Nucl Med. 39(5):865-9, 1998
- SMMI Procedure Guideline for Adult Solid-Meal Gastric-Emptying Study 2009
