Whole gut transit scintigraphy in the clinical evaluation of patients withupper and lower gastrointestinal symptoms

OBJECTIVE: In a single noninvasive, quantitative test, whole gut transit sc intigraphy (WGTS) measures gastric emptying (GE), small bowel transit (SBT) , and colonic transit (CT). The aim of this study was to investigate the cl inical utility of WGTS in patients with functional gastrointestinal (GI) sy mptoms. METHODS: A total of 108 patients with either dyspeptic upper GI symptoms (n = 35) or constipation (n = 73) underwent WGTS. Patients consumed a meal of 99 m-Tc egg sandwich with 111-In DTPA in water. They were imaged every 30 min for 6 h to measure GE and SBT, and at 24, 48, and 72 h to measure CT. RESULTS: Of 108 studies, 104 were analyzable. In patients with upper GI sym ptoms, 14/35 (40%) had delayed GE of solids, 4/35 (11%) delayed SBT, and 11 /35 (31%) delayed CT. Of those with constipation, 13/69 (19%) had delayed G E, 5/69 (7%) delayed SBT, and 43/69 (65%) delayed CT. WGTS changed the init ial clinical diagnosis in 47/104 (45%) and altered patient management in 70 /104 (67%) of the patients. CONCLUSIONS: Transit abnormalities of the upper GI tract and colon are comm on in patients with functional GI symptoms. Patients with upper GI symptoms frequently have delayed GE, whereas those with constipation tend to have p redominantly delayed CT. In many patients with functional GI symptoms, ther e was evidence of a diffuse GI motility disorder. Whole gut transit scintig raphy is a simple, clinically useful test, as it frequently leads to a chan ge in diagnosis and, therefore, patient management. (Am J Gastroenterol 200 0;95:2838-2847. (C) 2000 by Am. Coll. of Gastroenterology).