technetium-tc-99m-sulfur-colloid and Nausea

To investigate the current incidence and identify the current etiologies of rapid gastric emptying (dumping syndrome) in patients with a spectrum of gastrointestinal symptoms, including nausea, vomiting, abdominal pain, or diarrhea.. The results for a 4-h radionuclide gastric emptying test (GET) using a standardized scintigraphic technique were reviewed in 545 patients to see which patients met criteria for rapid gastric emptying, defined as >50% emptying of isotope-labeled solid meal at 1 h.. Forty-eight of 545 (8.8%) patients (28 females, mean age 46 +/- 2 years, range 32-58 years) had rapid GET. Seventeen of 59 (35%) met Rome III diagnostic criteria for cyclic vomiting syndrome (CVS). Twelve of these 59 (25%) patients were regarded as non-ulcer dyspepsia and six (13%) had dyspepsia in the setting of diabetes mellitus. Five (10.5%) were post-fundoplication surgery, where an accidental vagotomy was confirmed by sham meal challenge; previous gastric bypass surgery for obesity had been performed in three (6%) patients. Five (10.5%) patients with unexplained abdominal pain and diarrhea had the working diagnosis of irritable bowel syndrome.. Rapid gastric emptying can be identified in a sizeable subset (9%) of patients with unexplained nausea, vomiting, abdominal pain, and diarrhea when criteria are applied to the standardized scintigraphic gastric emptying meal.

Topics: Abdominal Pain; Adult; Diarrhea; Dumping Syndrome; Female; Gastric Emptying; Humans; Male; Middle Aged; Nausea; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Vomiting

Our aim was to determine whether domperidone could improve the symptoms of patients with gastroparesis, accelerate gastric emptying, and enhance quality of life.. Seventeen patients (13 women, 4 men; mean age 42.9 yr) with documented gastroparesis were evaluated. A baseline gastric emptying study was performed using an isotope-labeled solid meal and a follow-up study was repeated > or =6 months after initiating domperidone therapy. The severity of nausea, vomiting, abdominal pain, and bloating were obtained at baseline and at 6-month intervals and were graded from 0 to 5 (0 = none, 5 = most severe). Also, the number of hospital admissions were noted during the study period. Patients were asked to assess their overall health status and quality of life and were begun on domperidone 20 mg q.i.d. On average, patients received domperidone for 23.3 months (range 6-48 months). Domperidone doses ranged from 40 to 120 mg daily during the study period.. Gastroparesis symptom scores were reduced from 4.1 +/- 0.22 (mean +/- SEM) to 1.3 +/- 0.2, and hospital admissions were decreased significantly during the study compared with before domperidone therapy (p < 0.05). At baseline, patients had a 87.3 +/- 3.71% retention of a solid meal at 2 hours compared with a 57.2 +/- 5.04% retention during domperidone therapy (p < 0.05). Domperidone treatment enhanced the quality of life in 88% of patients. The mean prolactin level was 58.9 pg/ml during the study and three patients reported gynecomastia.. Chronic domperidone treatment in patients with gastroparesis significantly reduced GI symptoms and hospitalizations, enhanced quality of life, and accelerated gastric emptying of a solid meal to a normal rate. Domperidone successfully treats gastroparesis on a long-term outcome basis and has an excellent safety profile.

Topics: Abdominal Pain; Administration, Oral; Adult; Aged; Antiemetics; Domperidone; Dopamine Antagonists; Evaluation Studies as Topic; Female; Follow-Up Studies; Gastric Emptying; Gastroparesis; Gynecomastia; Health Status; Humans; Longitudinal Studies; Male; Middle Aged; Nausea; Patient Admission; Prolactin; Quality of Life; Radionuclide Imaging; Radiopharmaceuticals; Safety; Stomach; Technetium Tc 99m Sulfur Colloid; Treatment Outcome; Vomiting

A patient with a 4-month history of unexplained nausea and vomiting is reported. The only abnormality found initially was severe gastroparesis found by gastric emptying scan. Subsequently, a posterior fossa tumor was found. The pathogenesis of this unusual presentation and the role of the gastric emptying scan is discussed.

Topics: Adult; Cerebellar Neoplasms; Gastric Emptying; Humans; Male; Medulloblastoma; Nausea; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Vomiting

Nausea and vomiting are common complaints in chronic alcoholics. Autonomic neuropathy and esophageal motor abnormalities are frequently observed in chronic alcoholics, but gastric emptying has not been studied in these patients. Gastric emptying of a solid meal was measured, using 99mTc-sulfur colloid cooked in a scrambled egg, in 10 male chronic alcoholics with upper gastrointestinal complaints of nausea and vomiting. All patients were adequately nourished, recently drinking, but just over withdrawal and free of clinical peripheral neuropathy. Gastric emptying in 10 alcoholics was similar to 5 normal controls (t 1/2 115 +/- 12 versus 107 +/- 8 min). These data suggest that upper gastrointestinal symptoms in chronic alcoholics are not related to gastric motor dysfunction.

Topics: Adult; Alcoholism; Gastric Emptying; Humans; Male; Middle Aged; Nausea; Technetium Tc 99m Sulfur Colloid; Vomiting

The purpose of these studies was to develop a radiologic method for assessing gastric emptying of an indigestible solid in humans and to apply this technique to the evaluation of patients with diabetes mellitus. Thirty healthy subjects ingested 10 solid radiopaque markers (small pieces of nasogastric tubing) together with a standard meal (donuts and 7-Up). Radiographs of the upper abdomen were obtained hourly for up to 6 h until all markers had emptied from the stomach. Although most of the liquid component of the meal, labeled with 111In, emptied during the first hour (as assessed simultaneously by radionuclide scintigraphy), few radiopaque markers emptied from the stomach during the first 2 h after the meal. Most markers emptied during the fourth postprandial hour, and all 10 markers had emptied by 6 h in 45 of 46 experiments. In contrast, not all of the solid radiopaque markers emptied from the stomach by 6 h in 16 of 26 experiments in patients with diabetes mellitus (p less than 0.001 vs. healthy controls). In some experiments, 99mTc-labeled scrambled eggs were added to the meal so that emptying of this digestible solid, assessed by scintigraphy, could be compared with emptying of liquids and solid radiopaque markers. In healthy subjects, the digestible solid emptied more slowly than the liquid (t 1/2 = 154 +/- 11 min vs. 30 +/- 3 min, p less than 0.001), but emptying of digestible solid was significantly faster than the emptying of the indigestible solid radiopaque markers. In diabetics, emptying rates for the digestible solid and liquid were close to normal (t 1/2 = 178 +/- 5 min and 40 +/- 3 min, respectively), whereas indigestible solid markers were retained in the stomach 6 h after the meal in 50% of the patients. Radiopaque markers proved to be a simple method for measuring gastric emptying of indigestible solids in humans. Using this technique, patients with insulin-dependent diabetes mellitus had a high incidence of abnormally slow gastric emptying of indigestible solids; the method may be a more sensitive indicator of gastric motor dysfunction than radionuclide scintigraphy.

Topics: Adult; Aged; Barium Sulfate; Beverages; Contrast Media; Diabetes Mellitus, Type 1; Digestion; Female; Food; Gastric Emptying; Humans; Indium; Male; Middle Aged; Nausea; Pentetic Acid; Radiography; Radioisotopes; Radionuclide Imaging; Stomach; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid