A gastric emptying scan (GES) is an x-ray exam using special radioactive material that allows physicians to identify abnormalities related to emptying of the stomach. Diseases that involve changes in the way the stomach contracts (motility disorders) are best diagnosed by this test.
Purpose
The study is used most frequently to evaluate patients who have symptoms suggestive of decreased, delayed, or rapid gastric emptying, and no visible abnormality to explain their symptoms.
Symptoms pointing to a delay in gastric emptying are non-specific, and may be due to a number of causes, such as ulcers, diabetes, tumors, and others. These symptoms include nausea, upper abdominal bloating, and at times vomiting. Another significant symptom is called "early satiety," which means feeling full after eating only a small amount of food. In some patients, weight loss is also present. In addition to symptoms, the finding of a large amount of material in the stomach after an overnight fast suggests abnormal emptying, but does not distinguish between an actual blockage or an irregularity in gastric contractions. It is therefore essential to find out what is causing material to remain in the stomach.
Since many diseases can produce the above symptoms, structural lesions (such as tumors or regions of narrowing or scar tissue) need to be ruled out first. This is usually done by upper gastrointestinal series test or by endoscopy (examination of the inside of an organ, in this instance the stomach, with an instrument that has a light at the end of it and an optical system for examination of the organ). Once it is clear that a mechanical or physical lesion is not the cause of symptoms, attempts to document an abnormality in the nervous or muscular function of the stomach is then begun. GES is usually the first step in that evaluation.
Precautions
The exam should not be performed on pregnant women, but is otherwise quite safe. Since eggs are usually used to hold the radioactive material, patients should notify their physician if they are allergic to eggs. However, other materials can be used in place of an egg.
Description
Gastric emptying scans have undergone several changes since the initial studies in the late 1970s. During the study, patients are asked to ingest an egg sandwich containing a radioactive substance (for example, technetium) that can be followed by a special camera. The emptying of the material from the stomach is then followed and displayed both in the form of an image, as well as the percentage emptied over several hours (generally two and four hours). Studies are in progress using substances that are not radioactive, but this procedure is not available to the patient as of yet.
Preparation
The only preparation involved is for the patient to fast overnight before the test.
Risks
The radiation exposure during the study is quite small and safe, unless the patient is pregnant.
Normal results
There are several different measurements considered normal, depending on the radioactive material and solid meal used. The value is expressed as a percentage of emptying over a period of time. For a technetium-filled egg sandwich, normal emptying is 78 minutes for half the material to leave the stomach, with a variation of 11 minutes either way.
Abnormal results
GES scan studies that show emptying of the stomach in a longer than accepted period is abnormal. Severity of test results and symptoms do not always match; therefore, the physician must carefully interpret these findings. Diabetic injury to the nerves that supply the stomach (called diabetic gastroparesis) is one of the most common causes of abnormal gastric motility. However, up to 30% of patients have no obvious cause to explain the abnormal results and symptoms. These cases are called idiopathic (of unknown cause). GES is often used to follow the effect of medications used for treatment of motility disorders.
BOOKS
Camilleri, Michael, and Charlene M. Prather. "Gastric Motor Physiology and Motor Disorders." In Sleisenger & Fordtran's Gastrointestinal and Liver Disease, ed. Mark Feldman, et al. Philadelphia: W. B. Saunders Co., 1997.
Maurer, Alan H., Leon S. Malumd, and Robert S. Fisher. "Radionuclide Scintigraphy of the Gastrointestinal Tract." In Bockus Gastroenterology, ed. William S. Haubrich, et al. Philadelphia: W. B. Saunders Co., 1995.
PERIODICALS
Quigley, Eamonn. "Gastric and Small Intestinal Motility in Health and Disease." Gastroenterology Clinics of North America (Mar. 1996): 113-145.
ORGANIZATIONS
American Pseudo-obstruction and Hirschprung's Disease Society. 158 Pleasant St., North Andover, MA 01845-2797. <http://www.tiac.net/users/aphs>.
David Kaminstein, MD
KEY TERMS
Endoscopy—The examination of the inside of an organ with an instrument that has a light at the end of it and an optical system for examination of the organ.
Motility—Motility is spontaneous movement. One example is the automatic stomach contractions that move the food content along from the stomach into the intestines. A motility disease is one that involves changes in the way the stomach contracts.
