Dyspepsia (cont.)
Specific tests of gastrointestinal function
Esophageal motility study
Functional disorders of the esophagus can be
identified with esophageal motility studies (manometry). For these studies, a
pressure-sensing tube is swallowed and positioned within the esophagus.
Contractions of the esophageal muscle normally cause increases in pressure
within the esophagus that can be monitored by the catheter during and between
swallows of water. Among the abnormalities that can be seen are abnormally high
or abnormally low pressures during swallow-associated contractions and/or during
spontaneous contractions unassociated with swallows.
Gastric emptying study and electrogastrogram
Slow emptying of the
stomach is a common functional abnormality that can lead to bloating, nausea,
and vomiting. Rapid emptying of the stomach is relatively uncommon and can lead
to abdominal pain and diarrhea. Both of these abnormalities--slow and rapid emptying--can
be identified by a gastric emptying study.
The most common type of emptying study is a nuclear medicine study. In this
test, patients drink or eat food labeled with radioactive material. A Geiger counter-like device then is placed over the abdomen and the speed with which the
radioactive drink or food empties from the stomach is monitored.
The electrogastrogram (EGG) is like the electrocardiogram (ECG) for the
heart. Electrodes that are taped to the upper abdomen monitor the electrical
activity generated by the muscle of the stomach. Abnormalities of the electrical
rhythm of the stomach frequently are associated with dyspeptic symptoms,
particularly nausea and vomiting.
Barostatic study
A barostat is an instrument that is used to measure
pressure and determine the compliance (flexibility) of a gastrointestinal organ.
Compliance is a term that describes the effect that internal stretching has on
the organ. The greater the compliance of an organ, the less there is tension
(pressure) generated when the organ is stretched from within.
Compliance is important to the normal function of gastrointestinal organs.
For example, as food fills the stomach during a meal, the muscles of the stomach
must relax (comply) to accommodate the increasing volume of food. If the stomach
does not relax properly, the pressure in the stomach increases abnormally. It is
believed that abnormally high pressures within the stomach (due to reduced
compliance) can lead to symptoms such as early satiety (the feeling of abdominal
fullness or pain after only a small amount of food has been ingested).
The barostat includes a balloon that is placed within a gastrointestinal
organ through the mouth or anus. As the balloon is progressively blown up and
stretches the organ, the pressure within the organ is measured by the barostat.
In this way, abnormal compliance can be identified. Barostats can be placed in
the esophagus, stomach, small intestine or colon. Barostatic studies, however,
probably should be considered experimental. In fact, barostats and expertise in
their use are available in only a limited number of centers.
Small intestinal transit study
Small intestinal transit studies measure the
speed with which food travels through the small intestine. In the most common
type of transit study, a test meal that has been labeled with a radioactive
material is ingested. A Geiger-counter-like device is placed over the abdomen
and is used to follow the radioactive material through the small intestine and
into the colon. Rapid transit is associated with abdominal pain and diarrhea.
Slow transit also may be associated with abdominal pain. Although transit
studies are not difficult to conduct, they are not frequently used because
experience with their use is not wide-spread. They probably should be considered
experimental.
Antro-duodenal motility study
Antro-duodenal motility studies measure the
pressures that are generated by the contractions of the muscles of the antrum
(outlet) of the stomach and the duodenum. For these studies, a pressure-sensing
tube is swallowed or passed through the nose and positioned in the distal
(outlet) part of the stomach (the antrum) and the first part of the small
intestine (the duodenum). Pressures are measured with the stomach empty and
after a test meal. Abnormally high or low pressures as well as uncoordinated
contractions can be identified. These abnormalities are believed to be
associated with symptoms of dyspepsia. Antro-duodenal motility studies and
expertise in their use are not widely available.
Gallbladder emptying studies
Gallbladder emptying studies determine how well
the gallbladder empties. Between meals, the gallbladder stores bile that is
produced by the liver. After meals, the muscles of the gallbladder contract and
squeeze out (empty) most of the bile into the intestine. In the intestine, the
bile assists with the digestion of food.
For a gallbladder emptying study, a radioactive material is injected
intravenously. The radioactive material is removed from the blood by the liver
and accumulates with the bile in the gallbladder. The gallbladder then is
stimulated to contract with either a meal or an intravenous injection of a
hormone, called cholecystokinin. A Geiger-counter-like device is placed over the
abdomen and the speed with which the radioactivity leaves the gallbladder and
enters the intestine is monitored. Emptying studies of the gallbladder are
widely available since this technology is used for several purposes other than
measurement of gallbladder emptying.
It has been suggested that abnormally slow emptying of
the gallbladder may be associated with abdominal pain. Unfortunately, however,
the studies that support the association between slow gallbladder emptying and
symptoms are weak. Moreover, many people have abnormally slow emptying of the gallbladder but no
symptoms. For these reasons, abnormal emptying studies of the gallbladder
have not been widely accepted for diagnosing functional disorders of
the gallbladder. The lack of a clear association between dyspepsia and abnormalities
of gallbladder emptying is important since it means that patients with
abnormal emptying may not be improved by removal of their gallbladders.
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