Delayed gastric emptying

Case contributed by Dr Christopher Chen

Presentation

Weight loss, post-prandial nausea and fullness. History of poorly controlled T2DM.

Patient Data

Age: 40 years
Gender: Male
Nuclear medicine

There is evidence of abnormal retention within the stomach. The radiotracer retention at 1 hours was 93%, at 2 hours was 65%, at 3 hours was 54% and at 4 hours was 38%. This is consistent with delayed gastric emptying. Due to the background of poorly controlled type 2 diabetes this was attributed to gastroparesis.

Case Discussion

Gastroparesis is reduced emptying of the stomach that is not due to mechanical obstruction. Etiologies include diabetic vagal neuropathy, viral gastroenteritis, trauma, hyperglycemia and metabolic derangement. 

This study is a gastric emptying protocol with a radiolabelled strawberry jam and egg sandwich. Interestingly, the original protocol used chicken livers since there was superior labeling efficiency as the radiotracer bound tightly to the chicken Kupffer cells. This has naturally fallen out of favor and been replaced by egg whites.

The 4 hour acquisition is the most sensitive time point. 

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