Department of Internal Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
Neurogastroenterol Motil. 2013 Mar;25(3):e224-32. doi: 10.1111/nmo.12075. Epub 2013 Jan 15.
Scintigraphy, the gold standard to measure gastric emptying, is expensive and not widely available. Therefore, we compared emptying of radiopaque markers (ROM) from the stomach, by use of fluoroscopy, with scintigraphy in patients with insulin-treated diabetes.
On the same day we measured gastric emptying of 20 ROM using fluoroscopy and scintigraphic emptying of a standard solid meal. The subjects also completed a validated gastrointestinal (GI) symptom questionnaire.
We included 115 patients with insulin-treated diabetes (median age 53, range 21-69 years; 59 women). A moderately strong correlation was demonstrated between scintigraphic (% retained at 2 h) and ROM emptying (markers retained at 6 h) (r = 0.47; P < 0.0001). Eighty-three patients had delayed gastric emptying with scintigraphy, whereas only 29 patients had delayed emptying of ROM. Of the 29 patients with delayed emptying of ROM, 28 also had delayed scintigraphic emptying. The sensitivity and specificity of the ROM test was 34% and 97%, respectively. Significant correlations were only noted between scintigraphic gastric emptying and GI symptom severity, with the strongest correlations for fullness/early satiety (r = 0.34; P < 0.001) and nausea/vomiting (r = 0.30; P < 0.001).
CONCLUSIONS & INFERENCES: A gastric emptying test with ROM is a widely available screening method to detect delayed gastric emptying in patients with diabetes, where a positive result seems reliable. However, a normal ROM test does not exclude delayed gastric emptying, and if the clinical suspicion of gastroparesis remains, scintigraphy should be performed. Results from scintigraphy also correlate with GI symptom severity, which ROM test did not.
闪烁扫描术是测量胃排空的金标准，但价格昂贵且应用不广泛。因此，我们比较了透视法测量放射性标记物（ROM）排空与闪烁扫描术在胰岛素治疗糖尿病患者中的胃排空。
同一天，我们通过透视法测量 20 个 ROM 的胃排空，并进行标准固体餐的闪烁扫描排空。患者还完成了胃肠道（GI）症状问卷。
我们纳入了 115 名胰岛素治疗的糖尿病患者（中位年龄 53 岁，范围 21-69 岁；59 名女性）。闪烁扫描术（2 小时时保留的百分比）和 ROM 排空（6 小时时保留的标志物）之间显示出中度强相关性（r = 0.47；P < 0.0001）。83 名患者的闪烁扫描术显示胃排空延迟，而只有 29 名患者的 ROM 排空延迟。在 29 名 ROM 排空延迟的患者中，28 名患者也有闪烁扫描术显示的胃排空延迟。ROM 试验的敏感性和特异性分别为 34%和 97%。仅在闪烁扫描术胃排空与 GI 症状严重程度之间观察到显著相关性，与饱腹感/早饱（r = 0.34；P < 0.001）和恶心/呕吐（r = 0.30；P < 0.001）的相关性最强。
ROM 胃排空试验是一种广泛可用的筛查方法，可用于检测糖尿病患者的胃排空延迟，阳性结果似乎可靠。然而，ROM 试验正常并不能排除胃排空延迟，如果仍然怀疑胃轻瘫，应进行闪烁扫描术。闪烁扫描术的结果与 GI 症状严重程度相关，而 ROM 试验则没有。
