胃排空和肠道传输检测对疑似胃轻瘫临床管理决策的影响。
Influence of Gastric Emptying and Gut Transit Testing on Clinical Management Decisions in Suspected Gastroparesis.
机构信息
Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta, Georgia, USA.
出版信息
Clin Transl Gastroenterol. 2019 Oct;10(10):e00084. doi: 10.14309/ctg.0000000000000084.
INTRODUCTION
Gastric emptying scintigraphy (GES) or wireless motility capsules (WMCs) can evaluate upper gastrointestinal symptoms in suspected gastroparesis; WMC tests can also investigate lower gut symptoms. We aimed to determine whether these tests impact treatment plans and needs for additional diagnostic evaluation.
METHODS
In a prospective, multicenter study, 150 patients with gastroparesis symptoms simultaneously underwent GES and WMC testing. Based on these results, investigators devised management plans to recommend changes in medications, diet, and surgical therapies and order additional diagnostic tests.
RESULTS
Treatment changes were recommended more often based on the WMC vs GES results (68% vs 48%) (P < 0.0001). Ordering of additional test(s) was eliminated more often with WMC vs GES (71% vs 31%) (P < 0.0001). Prokinetics (P = 0.0007) and laxatives (P < 0.0001) were recommended more often based on the WMC vs GES results. Recommendations for prokinetics and gastroparesis diets were higher and neuromodulators lower in subjects with delayed emptying on both tests (all P ≤ 0.0006). Laxatives and additional motility tests were ordered more frequently for delayed compared with normal WMC colonic transit (P ≤ 0.02). Multiple motility tests were ordered more often on the basis of GES vs WMC findings (P ≤ 0.004). Antidumping diets and transit slowing medications were more commonly recommended for rapid WMC gastric emptying (P ≤ 0.03).
DISCUSSION
WMC transit results promote medication changes and eliminate additional diagnostic testing more often than GES because of greater detection of delayed gastric emptying and profiling the entire gastrointestinal tract in patients with gastroparesis symptoms.
TRANSLATIONAL IMPACT
Gastric scintigraphy and WMCs have differential impact on management decisions in suspected gastroparesis.
简介
胃排空闪烁显像（GES）或无线动力胶囊（WMC）可用于评估疑似胃轻瘫患者的上消化道症状；WMC 测试还可用于调查下消化道症状。我们旨在确定这些测试是否会影响治疗计划和对额外诊断评估的需求。
方法
在一项前瞻性、多中心研究中，150 名有胃轻瘫症状的患者同时接受 GES 和 WMC 测试。根据这些结果，研究人员制定了管理计划，建议改变药物、饮食和手术治疗，并安排额外的诊断测试。
结果
基于 WMC 与 GES 结果，推荐的治疗变化更多（68%比 48%）（P < 0.0001）。与 GES 相比，WMC 更常消除额外测试的订单（71%比 31%）（P < 0.0001）。基于 WMC 与 GES 结果，推荐更多的促动力剂（P = 0.0007）和泻药（P < 0.0001）。在两种测试均显示排空延迟的患者中，促动力剂和胃轻瘫饮食的推荐更高，神经调节剂更低（所有 P ≤ 0.0006）。与正常的 WMC 结肠转运相比，WMC 转运延迟时更频繁地开出泻药和额外的动力测试（P ≤ 0.02）。基于 GES 与 WMC 结果，更频繁地开出多项动力测试（P ≤ 0.004）。快速 WMC 胃排空时，更常推荐抗倾倒饮食和转运减缓药物（P ≤ 0.03）。
讨论
WMC 转运结果比 GES 更频繁地促进药物变化并消除额外的诊断测试，因为它能更有效地检测到胃排空延迟，并在有胃轻瘫症状的患者中对整个胃肠道进行分析。
翻译后的中文
简介
胃排空闪烁显像（GES）或无线动力胶囊（WMC）可用于评估疑似胃轻瘫患者的上消化道症状；WMC 测试还可用于调查下消化道症状。我们旨在确定这些测试是否会影响治疗计划和对额外诊断评估的需求。
方法
在一项前瞻性、多中心研究中，150 名有胃轻瘫症状的患者同时接受 GES 和 WMC 测试。根据这些结果，研究人员制定了管理计划，建议改变药物、饮食和手术治疗，并安排额外的诊断测试。
结果
基于 WMC 与 GES 结果，推荐的治疗变化更多（68%比 48%）（P < 0.0001）。与 GES 相比，WMC 更常消除额外测试的订单（71%比 31%）（P < 0.0001）。基于 WMC 与 GES 结果，推荐更多的促动力剂（P = 0.0007）和泻药（P < 0.0001）。在两种测试均显示排空延迟的患者中，促动力剂和胃轻瘫饮食的推荐更高，神经调节剂更低（所有 P ≤ 0.0006）。与正常的 WMC 结肠转运相比，WMC 转运延迟时更频繁地开出泻药和额外的动力测试（P ≤ 0.02）。基于 GES 与 WMC 结果，更频繁地开出多项动力测试（P ≤ 0.004）。快速 WMC 胃排空时，更常推荐抗倾倒饮食和转运减缓药物（P ≤ 0.03）。
讨论
WMC 转运结果比 GES 更频繁地促进药物变化并消除额外的诊断测试，因为它能更有效地检测到胃排空延迟，并在有胃轻瘫症状的患者中对整个胃肠道进行分析。
翻译后的英文
INTRODUCTION
Gastric emptying scintigraphy (GES) or wireless motility capsules (WMCs) can evaluate upper gastrointestinal symptoms in suspected gastroparesis; WMC tests can also investigate lower gut symptoms. We aimed to determine whether these tests impact treatment plans and needs for additional diagnostic evaluation.
METHODS
In a prospective, multicenter study, 150 patients with gastroparesis symptoms simultaneously underwent GES and WMC testing. Based on these results, investigators devised management plans to recommend changes in medications, diet, and surgical therapies and order additional diagnostic tests.
RESULTS
Treatment changes were recommended more often based on the WMC vs GES results (68% vs 48%) (P < 0.0001). Ordering of additional test(s) was eliminated more often with WMC vs GES (71% vs 31%) (P < 0.0001). Prokinetics (P = 0.0007) and laxatives (P < 0.0001) were recommended more often based on the WMC vs GES results. Recommendations for prokinetics and gastroparesis diets were higher and neuromodulators lower in subjects with delayed emptying on both tests (all P ≤ 0.0006). Laxatives and additional motility tests were ordered more frequently for delayed compared with normal WMC colonic transit (P ≤ 0.02). Multiple motility tests were ordered more often on the basis of GES vs WMC findings (P ≤ 0.004). Antidumping diets and transit slowing medications were more commonly recommended for rapid WMC gastric emptying (P ≤ 0.03).
DISCUSSION
WMC transit results promote medication changes and eliminate additional diagnostic testing more often than GES because of greater detection of delayed gastric emptying and profiling the entire gastrointestinal tract in patients with gastroparesis symptoms.
TRANSLATIONAL IMPACT
Gastric scintigraphy and WMCs have differential impact on management decisions in suspected gastroparesis.
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