Diagnosis of Gastroparesis
How is gastroparesis diagnosed?
A history of early satiety, bloating, nausea, regurgitation or vomiting with meals would normally prompt an evaluation to determine the cause of symptoms
. Inflammation, ulcer disease, or obstruction by a tumor can also cause these symptoms and diagnostic tests would be used to determine the cause. Radiographic tests, endoscopic procedures, and motility tests
are used to exclude obstruction, to view the stomach lining and obtain biopsies, and to examine muscle contraction patterns. These tests are described below.
Upper Endoscopy is a test that is performed by inserting a thin flexible tube through the mouth into the stomach. The endoscope has camera capabilities and allows the upper gastrointestinal tract to be evaluated for ulcers, inflammation, cancers, hernias or other abnormalities. These conditions can cause symptoms similar to gastroparesis. Upper endoscopy usually requires 10-15 minutes to complete. Medication is usually administered intravenously immediately before the test for comfort and sedation. If abnormal findings such as an ulcer or inflammation are noted biopsies can be obtained.
Gastric Emptying Study is a widely available nuclear medicine test that examines the rate of emptying of solid or liquid material from the stomach. A delay in gastric emptying indicates a diagnosis of gastroparesis. Subjects consume an egg or oatmeal meal containing a tiny amount of the radioactive material (99m Tc), which is measured by a scanning technique as it empties from the stomach.
Scintigraphic Gastric Emptying is a test that measures the volume of stomach contents before and after a meal, or how well the stomach relaxes in response to food intake. This test uses a tiny amount of radioactive material (In111) which is selectively taken up by the lining of the stomach, and indirectly measures the volume of the stomach. The subject consumes a nutrient drink over 30 seconds. A scan of the stomach is taken before and after the nutrient drink. The test indicates whether the stomach relaxes appropriately when filled. Symptoms of poor stomach relaxation can be identical to poor emptying, and this test can help distinguish the processes. Scintigraphic gastric emptying is not readily available.
Gastroduodenal manometry is a test that measures how well the smooth muscle of the stomach and small intestine contracts and relaxes. The test is performed by placing a thin tube into the stomach usually with the aid of the endoscope. The tube is advanced into the small intestine and over the next few hours the contractile responses while the subject is fasting and eating are observed and recorded. The manometry catheter provides information on how strong and how often the muscles of the stomach and intestine contract and whether the stomach contractions are coordinated with the contractions in the small bowel. Gastric duodenal manometry may be helpful but is often not needed to make a diagnosis of gastroparesis. This test is not widely available.
A Small Intestinal X-ray is a contrast radiograph used to outline the anatomy of the small bowel. This study is not generally needed to make a diagnosis of gastroparesis, but a blockage anywhere in the small intestine will result in a back up of material and could account for delayed gastric emptying. An obstruction in the small bowel may cause symptoms similar to gastroparesis, but the treatment is different. Treatment for intestinal obstruction is complete bowel rest until the cause of obstruction such as inflammation resolves or surgery to remove the blockage.
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