Dyspeptic symptoms, such as pain after eating, bloating and nausea all have major impact on quality of life and health care costs. When no structural cause is identified, patients are diagnosed with functional dyspepsia. This trial aims to identify objective abnormalities of stomach function that explain patient's symptoms and establish diagnosis. Another group are diabetic patients who can often develop similar symptoms, labelled as diabetic gastroparesis. In some cases this is associated with delayed gastric emptying but not all. 24 patients with functional dyspepsia will be studied and 24 healthy controls (to establish normal ranges) and 24 diabetic patients with symptoms of functional dyspepsia. The utility of 3 different non-invasive investigations will be assessed. At screening the nutrient drink test (NDT) asks the patient to drink 40ml of milkshake (0.75kcal/ml) every minute and score symptoms every 5 minutes. The patient continues until they reach the maximum tolerated volume. Participants will then be randomized to undergo non-invasive imaging on two separate test days by magnetic resonance imaging (MRI) and gastric scintigraphy MRI will be completed with the patient ingesting 400ml of milkshake (identical to NDT) and 12 agar beads (no additional calories) of known breaking strength. The emptying of the stomach will be visualised with the MRI alongside symptom recording. Gamma scintigraphy will ingest the same meal as for the MRI scan but radioactive labelling will allow the rate of liquid and solid meal emptying to be visualised alongside symptom recording. Additionally, blood sugars will be recorded before nutrient drink test and at 15 and 30 minutes following ingestion of 400ml of milkshake and 12 agar beads. Data will be analyzed to assess the association of objective abnormalities of gastric function and patient symptoms. Additionally the results of non-invasive imaging by MRI and GS will be compared to assess the optimal measurement of gastric function and emptying in this clinical scenario.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
DIAGNOSTIC
Masking
NONE
Enrollment
72
400ml of milkshake and 12 agar beads are ingested and gamma scintigraphy scanning completed to document gastric emptying and outcome measures listed earlier.
400ml of milkshake and 12 agar beads are ingested and gamma scintigraphy scanning completed to document gastric emptying and outcome measures listed earlier.
National Institute of Health Research Biomedical Research Unit, Nottingham Digestve Diseases Centre, University of Nottingham,
Nottingham, United Kingdom
Maximum volume ingested at nutrient drink test (ml)
Maximum of milkshake ingested at maximum satiety
Time frame: Study Day
Gastric emptying rate (ml/min) for liquids
gastric emptying rate measured by non-invasive imaging
Time frame: Study day
Gastric emptying rate (ml/min) for solids
Gastric emptying rate measured by non-invasive imaging
Time frame: Study Day
Time taken for 50% gastric emptying (T50, minutes) for liquids
time taken for 50% of gastric contents to leave the stomach
Time frame: Study day-After 50% of contents of stomach has emptied
Time take for 50% gastric emptying (T50, minutes) solids
Time taken for 50% of gastric contents to leave the stomach
Time frame: Study day-after 50% of contents of stomach has emptied
Sensation at 200ml, 400ml and at completion of nutrient drink test (fullness, bloating, nausea, heartburn, epigastric pain)
Visual analogue score for each sensation (score up to 100 points)
Time frame: Study day
Glycaemic response at 15 minutes and 30 minutes post 400ml milkshake
Blood glucose (mmol/l)
Time frame: study day
Gastric volume at 200ml nutrient ingestion
Measurement of gastric volume (ml) on MRI and gamma scintigraphy
Time frame: Study day
Gastric volume at 400ml nutrient ingestion
measurement of gastric volume (ml) on MRI and gamma scintography
Time frame: study day
Gastric contractile wave contractile frequency
contractile frequency within stomach
Time frame: study day
Oro-caecal Transit time
Time taken for 50% gastric contents to enter caecum
Time frame: study day
Sensation threshold volume for fullness, bloating, nausea, heartburn and epigastric pain
Gastric volume recorded at time of maximum symptom scores
Time frame: study day
Sensation at 200ml and 400ml ingestion of test meal (fullness, bloating, nausea, heartburn, epigastric pain)
Visual analogue score for each sensation (score up to 100 points)
Time frame: study day
GI Hormone Assessment
5 ml of blood will be taken at time 0, 30, 60 and 120 min. GI peptide hormones will then be analysed from the samples.
Time frame: Study day
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