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

To compare the efficacy of gastric lavage and ipecac-induced emesis by using a radionuclide marker in a simulated overdose and to determine the amount of material recoverable after lavage fluid appears clear.. Case-control, prospective cross-over study.. Nuclear medicine department of Valley Medical Center, Fresno, California.. Fourteen male and five nonpregnant female adult volunteers with no pre-existing gastrointestinal disease and no medication use.. In phase 1, each volunteer ingested 30 capsules labeled with a measured amount of Tc99m with 75 mL H2O followed in five minutes by ipecac-induced emesis. In phase 2, two to four weeks later, each subject was lavaged after ingesting 30 labeled capsules. After lavage appeared clear, a 1,000-mL supplemental lavage was done and analyzed separately. All emesis or gastric lavage fluid was collected and measured for tracer activity.. All subjects in the ipecac group vomited with an average time from ipecac to emesis of 19 minutes. Two subjects withdrew from the study, refusing to complete lavage due to discomfort. Based on retrieved material, ipecac-induced emesis returned significantly more tracer (mean +/- SD, 54.1 +/- 21.3%) than lavage until clear (mean +/- SD, 30.3 +/- 17.4%) (P = .0021). Supplemental lavage returned 12.9% of the total recovered marker (SD, 11.6%). The total of initial and supplemental returns from lavage was 35.5% (SD, 21.0%). This return was significantly less than that returned by ipecac-induced emesis (P = .016).. In this study, ipecac-induced emesis was significantly more effective than gastric lavage in emptying the stomach after simulated overdose. Significant amounts of ingested material are recoverable in gastric lavage return after it appears clear.

Topics: Adult; Case-Control Studies; Female; Gastric Emptying; Gastric Lavage; Humans; Ipecac; Male; Prospective Studies; Radionuclide Imaging; Reproducibility of Results; Technetium Tc 99m Sulfur Colloid; Vomiting

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

Children with cyclic vomiting syndrome have a characteristic periodicity, and this could be due to abnormal gastric myoelectrical activity detectable by cutaneous electrogastrography (EGG). Fifteen children, aged 4-15 years, with CVS (eight symptomatic and seven asymptomatic at the time of study) underwent EGG and were compared to five normal and four disease control children. The relative tachygastria activity (RTA) or power ratio was calculated in each group. Five of the eight symptomatic CVS children showed marked episodes of tachygastria preprandially and all showed tachygastria postprandially. The asymptomatic CVS children showed tachygastria only postprandially after the test meal. RTA index and or power ratio of symptomatic children was significantly different from the asymptomatic CVS children (P = 0.001), normal (P = 0.007) and disease control children (P = 0.006). In a subsequent study, 2-hr gastric emptying 99mTc scintiscans were performed in 28 CVS children and compared to eight healthy control children. Twelve of 16 CVS children (75%) showed abnormal gastric emptying, and 7 of 28 (25%) showed abnormal EGG with significant tachygastria. The CVS children had significantly higher RTA both preprandially (P < 0.05) and postprandially (P < 0.05). Our results demonstrate that accelerated gastric rhythm was seen during the acute episodes of half of the CVS patients studied. Abnormal EGGs and higher RTA or power ratios were associated with delayed gastric emptying in the CVS children. Abnormal gastric myoelectrical activity may play a role in the pathogenesis of CVS syndrome.

Topics: Adolescent; Adult; Child, Preschool; Electrodiagnosis; Female; Gastric Emptying; Humans; Male; Myoelectric Complex, Migrating; Periodicity; Postprandial Period; Signal Processing, Computer-Assisted; Stomach; Syndrome; 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

It is well established that liquid emptying occurs in the absence of motor activity of the stomach. In contrast, solid-phase emptying is controlled in part by antral peristalsis and is, therefore, a more precise indicator of gastric motility. We developed a semisolid, radionuclide gastric emptying test using rice cereal and technetium-99m-sulfur colloid to assess antral physiology in infants with vomiting. Computer-programmed mathematical models were used to determine the shape of a line that best fit our emptying data points. Linear, simple exponential [f = 2-(t/t1/2)], and power exponential [f = 2(t/t1/2)beta] patterns of emptying were calculated, where f is the fraction of the meal remaining in the stomach at time t, and t1/2 is the time when 50% of the meal has emptied and is a determinant of the shape of the curve. In infants with simple regurgitation (chalasia) and those with vomiting and failure to gain weight, we made statistical comparisons between gastric emptying patterns after analysis of the mean percentage of retained radionuclide at 120 min, calculated t1/2, and area under the curve. The coefficient of determination, R2, was calculated as an index of whether a curve provided goodness of fit to the data. Differences between groups of patients were statistically significant for all parameters of each mathematical model. However, higher coefficients of determination were noted in the power exponential model. The data suggest that the power exponential mathematical model provides the best analysis of the gastric emptying patterns for infants with chalasia and those with vomiting and failure to gain weight.(ABSTRACT TRUNCATED AT 250 WORDS)

Topics: Adsorption; Failure to Thrive; Gastric Emptying; Gastroesophageal Reflux; Humans; Infant; Kinetics; Models, Biological; Oryza; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; 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