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Gastroparesis
Paula Vergara-Wentland, MD; Paige Bennett, MD
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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)

        IMAGING

        • General Features

          • Imaging Recommendations

            DIFFERENTIAL DIAGNOSIS

              PATHOLOGY

              • General Features

                CLINICAL ISSUES

                • Treatment

                  DIAGNOSTIC CHECKLIST

                  • Consider

                    • Image Interpretation Pearls

                      Selected References

                      1. 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
                      2. Maurer AH et al: Appropriate use criteria for gastrointestinal transit scintigraphy. J Nucl Med. 61(3):11N-17N, 2020
                      3. 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
                      4. 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
                      5. Shin AS et al: Diagnostic assessment of diabetic gastroparesis. Diabetes. 62(8):2667-73, 2013
                      6. 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
                      7. 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
                      8. Heyman S: Gastric emptying in children. J Nucl Med. 39(5):865-9, 1998
                      9. SMMI Procedure Guideline for Adult Solid-Meal Gastric-Emptying Study 2009
                      Related Anatomy
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                      Related Differential Diagnoses
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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)

                            IMAGING

                            • General Features

                              • Imaging Recommendations

                                DIFFERENTIAL DIAGNOSIS

                                  PATHOLOGY

                                  • General Features

                                    CLINICAL ISSUES

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. 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
                                          2. Maurer AH et al: Appropriate use criteria for gastrointestinal transit scintigraphy. J Nucl Med. 61(3):11N-17N, 2020
                                          3. 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
                                          4. 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
                                          5. Shin AS et al: Diagnostic assessment of diabetic gastroparesis. Diabetes. 62(8):2667-73, 2013
                                          6. 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
                                          7. 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
                                          8. Heyman S: Gastric emptying in children. J Nucl Med. 39(5):865-9, 1998
                                          9. SMMI Procedure Guideline for Adult Solid-Meal Gastric-Emptying Study 2009