An Integrated Assessment of Gastric Functions
Upper gastrointestinal (GI) symptoms are experienced by =20% of patients with diabetes. Dysfunctions of gastric motility, emptying (GE), and accommodation are postulated to underlie these symptoms. However, the relationship between these disturbances and daily symptoms is limited. The pathogenesis of delayed (or rapid) GE in diabetic gastroenteropathy is unclear because the manometric assessment of gastroduodenal motility is a cumbersome and invasive technique. To overcome these limitations, we developed a technique to simultaneously measure GE and gastric motility with scintigraphy. Scintigraphy is the criterion standard for assessing GE. We also developed a magnetic resonance imaging (MRI)-based technique to assess gastric motility. Moreover, we have demonstrated that symptoms during a GE study are correlated with the severity of daily symptoms. In this study, we propose to integrate the scintigraphic assessment of GE, gastric antral motility, and the symptoms during a GE study into a single test. The aims of this research are to: (i) evaluate the relationship between gastric antral motility and GE assessed with integrated scintigraphy in healthy people and patients with diabetic gastroenteropathy, (ii) compare gastric antral motility measured with MRI and scintigraphy, and (iii) evaluate the contribution of GE, gastric motility, and gastric accommodation (as assessed via MRI), and symptoms during a GE study, to daily symptoms in patients with diabetic gastroenteropathy. Ten healthy individuals and 30 patients with diabetes and upper GI symptoms (10 each with normal, rapid, and delayed GE) will undergo integrated scintigraphy and a dynamic gastric MRI. We predict that integrated scintigraphy, which can be performed with existing scanners, will provide a refined characterization of phenotypes in patients with diabetic gastroenteropathy, enhance our understanding of the mechanism(s) of delayed (or rapid) GE, and help identify predictors of the response to medical and/or endoscopic therapy in future.

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