Gastroparesis Diagnosis

General patient’s assessment begins with typical symptoms (nausea, vomiting, bloating, abdominal pain, and early satiety) of gastroparesis starts with exclusion of mechanical causes.

Diagnosis test for gastroparesis

If not suspecting any mechanical, then exclusion of medication-induced symptoms must also perform. The most common cause of delay in gastric emptying is using certain medications such as narcotics or glucagon-like peptide agonists.

If suspect mechanical obstruction, then imaging with x-rays or computed tomography can confirm obstruction and exclude gastric emptying delay as a primary cause.

A patient who is totally off from all medications (that may induce symptoms of gastroparesis, such as narcotics or glucagon-like peptide agonists) and who retains at least 25% of the gastric content at four hours would diagnose as gastroparesis.

Ultrasound

Ultrasound or ultrasonography is an imaging test using sound waves to create pictures of body organs. Trans-abdominal ultrasonography measures various parameters of gastric-motor function. Gastric emptying is considering complete once the antral area returns to the fasting baseline level. Testing may be difficult in case of obese individuals.  

Upper endoscopy

This procedure passes a thin tube with a camera (endoscope) down the esophagus to assess the stomach lining.

Barium X-ray

You require drinking a liquid (barium), which coats the esophagus, stomach, and small intestine and help to show up on X-ray. This test is otherwise calling as an upper GI (gastrointestinal) series or barium swallows, which helps in the assessment of mucosal lesions. Little or no emptying of barium within 30 minutes and retention of gastric barium after six hours is suggestive of gastroparesis.

Scintigraphy

Scintigraphy is a diagnostic test using a nuclear medicine (a radioisotopes) taken internally and an external detector (gamma cameras produce two-dimensional images, and SPECT & positron emission tomography (PET) produces 3-dimensional image's capture the emitted radiation from this radioisotope.

Scintigraphic is considering as the best standard for the gastroparesis diagnosis. It supports assessment of both solid and liquid emptying.  Scintigraphic gastric emptying of the solids challenges is the most preferable. Gastric-retention of solids takes four hours for assessment. If you prefer a shorter duration (60 to 120 minutes) assessment, go for the liquid challenge with decreased sensitivity. Standards of abnormal stomach emptying have established for one, two, three, and four hours. Confirm gastric emptying if more than 10% of the stomach content retains at four hours. You should stop taking medications such as narcotics, motility agents, and glucagon-like peptide agonists for five to seven days before undergo testing, these medications may interfere.

Breathe testing for gastroparesis

Breathe testing for gastroparesis using the non-radioactive isotope C bound to a digestible substance. The C-labeled octanoate; a medium chain triglyceride is bound into a solid meal, acetate or to proteinaceous algae (Spirulina). Once ingestion and after stomach emptying it is absorbed into the small intestine and metabolized to CO2, which has expelled from the lungs during respiration. Thus, breath testing provides a measure of solid phase emptying.

EGG

EGG records gastric myoelectric activity of the slow-wave by fixing cutaneous electrodes to the anterior abdomen overlying the stomach. The healthy slow wave frequency is three cycles per minute and meal ingestion increases the amplitude. Generally, an EGG is considering as abnormal if the dysrhythmias exceed 30% of normal range and/or no increase in signal amplitude after meal ingestion.

Antroduodenal Manometry

Antroduodenal manometry provides information about gastric and duodenal motor function in both fasting and postprandial periods.  Perform this test in stationary settings over a five to an eight-hour period. During this test, after sedation your doctor will insert a manometry catheter into the pyloric channel with endoscopic guidance. It records pressure measurements for information about the small bowel and gastric pressure ratio during resting, mealtime, and after medication usage. This manometry test can differentiate myopathic and neuropathic causes of symptoms. Myopathy is present if amplitude of the muscle pressures of less than 30 mmHg and neuropathy if there is any coordinated bursts of muscle activity.

Wireless capsule motility testing

Wireless capsule motility testing is to assess motility by collecting and analyzing data of the entire GI tract. The patients require ingesting a capsule that measure pressures, pH, temperature and expulsion time after traveling across the full GI tract. This capsule is a one-time use device, once activated and swallowed by the patient. The patient should take the pill after eating a standardized meal and require wearing a small monitor that record data telemetrically.