Noninvasive measurement of gastric accommodation in patients with idiopathic nonulcer dyspepsia

OBJECTIVES: Postprandial symptoms are associated with impaired postprandial gastric accommodation. The aims of this study were to apply a noninvasive method to measure accommodation of the entire stomach in healthy subjects a nd in patients with idiopathic dyspeptic symptoms, and to assess the freque ncy of abnormal gastric accommodation and emptying of solids in these patie nts. METHODS: In 20 healthy volunteers and 32 tertiary referral patients, we use d i.v. Tc-99m-single photon emission computed tomography (SPECT) to measure fasting and postprandial gastric volumes; we expressed the volume response to feeding ("accommodation") as the change in gastric volume and the ratio of postprandial/fasting volumes. The stomach was identified in transaxial SPECT tomographic images using a semiautomated, intensity-based extraction algorithm. Whole gastric volumes were measured using Analyze(AVW) software. Gastric emptying in patients was measured by scintigraphy. We also assesse d dyspeptic symptoms and the association with normal or reduced accommodati on. RESULTS: SPECT imaging detects the postprandial change in gastric volume (" accommodation") in health and disease. Among healthy subjects (eight men, 1 2 women), the post-prandial/fasting gastric volume ratio was 4.9 +/- 1.7 (m ean +/- SD; fifth through 95th percentiles 3-8, median 4.6). Thirteen (41%) patients with idiopathic nonulcer dyspepsia had reduced postprandial "acco mmodation." Gastric emptying was fast in four (13%), normal in 25 (78%), an d slow in three (9%) patients. Both tests were normal in 50% of patients. W eight loss of > 10 pounds tended to be more frequently observed in those wi th reduced "accommodation" (62% vs 32%, p = 0.09). CONCLUSIONS: SPECT imaging noninvasively measures fasting and postprandial gastric volumes in humans. Half the patients with idiopathic nonulcer dyspe psia had impaired gastric accommodation or emptying. Reduced gastric "accom inodation" was observed in 41% of a group with idio opathic nonulcer dyspep sia. Abnormal gastric emptying is less frequent (22%). (C) 2001 by Am. Coll . of Gastroenterology.