technetium-tc-99m-lidofenin and Dyspepsia

Frequently, patients present with symptoms after cholecystectomy (pain or discomfort in the upper part of the abdomen, postprandial fullness, bile vomiting, among others). Duodenogastric reflux has been associated with these symptoms in some patients. Therefore, this study was done to investigate this relationship.. We evaluated duodenogastric reflux (DGR) in ten healthy patients, in ten patients who had asymptomatic simple cholecystectomy, in ten patients who had asymptomatic cholecystectomy with supraduodenal choledochoduodenostomy (CD), and in ten patients who had cholecystectomy plus CD followed by discomfort in the upper abdomen, postprandial fullness and bile vomiting, but no colicky pain or acute cholangitis. Duodenogastric reflux was quantified using continuous intravenous infusion of technetium-99m labeled hepatoiminodiacetic acid (99mTc-HIDA) and subsequently determining its concentration in gastric juice.. All of the patients who underwent operation, whatever the technique used, had higher reflux rates than those in the control group (p < 0.001). Moreover, reflux rates were comparable in the patients who underwent simple cholecystectomy compared with patients in the asymptomatic cholecystectomy plus CD group. Conversely, when patients with cholecystectomy plus CD presented with discomfort in the upper part of the abdomen as well as bile vomiting, they had higher reflux rates than patients who underwent simple cholecystectomy (p < 0.001) and asymptomatic patients with associated CD (p < 0.001).. Our results suggest that DGR must be involved in the genesis of these dyspeptic symptoms.

Topics: Abdominal Pain; Bile; Cholecystectomy; Choledochostomy; Duodenogastric Reflux; Dyspepsia; Female; Gastric Juice; Humans; Imino Acids; Infusions, Intravenous; Male; Middle Aged; Organotechnetium Compounds; Radionuclide Imaging; Technetium Tc 99m Lidofenin; Vomiting

Cholescintigraphy with technetium 99m hydroxy imino diacetic acid (99mTc-HIDA) was used to study gallbladder emptying (GE) and duodenogastric reflux (DGR) simultaneously during the postprandial period in humans. Two groups of subjects were examined prospectively; one was a group of healthy volunteers (n = 14) and the other a group of patients with non-ulcerous dyspepsia (NUD) (n = 22). Symptoms were quantified using a clinical score (CS). GE kinetics was quantified according to two indices. DGR episodes were detected by an image-subtraction method and quantified. The group of patients with NUD showed significant early acceleration of GE (P less than 0.01). One DGR episode equivalent to 1% of the injected dose was observed in 1 of the 14 control subjects, and greater than 1% in 3 of the 22 NUD patients. However, there was no correlation between the CS, GE kinetics and DGR episodes. The physiopathological mechanism and clinical significance of these digestive motility anomalies remain to be demonstrated.

Topics: Adult; Duodenogastric Reflux; Dyspepsia; Female; Food; Gallbladder; Humans; Imino Acids; Male; Middle Aged; Organotechnetium Compounds; Prospective Studies; Radionuclide Imaging; Technetium Tc 99m Lidofenin