Validation of a Single-Time-Point Measurement of Total Abdominal Counts to Simplify Small Bowel and Colon Transit Analyses.

The Society of Nuclear Medicine and Molecular Imaging and European Association of Nuclear Medicine procedure guide on gastrointestinal transit currently indicates that the mean of total abdominal counts of 7 time points (0-360 min) is used to define the total abdominal counts for bowel transit studies. The purpose of this study was to investigate the variability of total abdominal counts during the initial 6 h of bowel transit and to determine whether a simplified, single-time-point measurement can be used. METHODS: Thirty consecutive bowel transit studies were retrospectively analyzed. Patients received an oral dose of 4.6 MBq (125 µCi) of 111In-DTPA in 300 cc of water together with a standard egg white solid-phase, gastric-emptying meal to measure small bowel and colon transit. 111In-DTPA geometric mean and decay-corrected total abdominal counts obtained at 0, 30, 60, 120, 180, 240, 300, and 360 min after meal ingestion were analyzed. The coefficient of variation was used to determine the variability of the mean total abdominal counts. Slope of the regression line, Student t test, and a Pearson product-moment correlation coefficient (PCC) were also calculated to determine the correlation of total abdominal counts at each time point compared with the mean of all time points. RESULTS: The mean coefficient of variation of total abdominal counts of each patient was 3.3%, with a range of 1.1%-6.3%. The mean of the slope of the regression line of the total abdominal counts of the patients was -0.001 ± 0.003. There was no significant difference between the measured slope of the regression line compared with a line with a slope of 0 (P > 0.05). When the counts at each time were compared with the mean counts, there was no significant difference (P > 0.05). The PCC of each of the counts showed a significant and strong correlation between each interval and the mean total abdominal counts (P < 0.01). CONCLUSION: There is no significant variability in geometric mean 111In-DTPA total abdominal counts during the initial 6 h of bowel transit studies. This can permit a more simplified analysis using the total abdominal counts from only a single time point.

Domperidone to Treat Symptoms of Gastroparesis: Benefits and Side Effects from a Large Single-Center Cohort.

BACKGROUND: There is increased awareness about risks and benefits of using domperidone to treat gastroparesis. AIM: To describe the outcome of treating patients with refractory gastroparesis symptoms with domperidone. METHODS: Domperidone 10 mg QID or TID was prescribed to patients with refractory gastroparesis symptoms; follow-up obtained at 2-3 months assessing symptoms and side effects. Patients filled out Patient Assessment of Upper GI Symptoms prior to treatment and at follow-up along with Clinical Patient Grading Assessment Scale (CPGAS, +7 = completely better; 0 = no change). RESULTS: Of 125 patients initially prescribed domperidone, 7 did not take this medication and 3 were lost to follow-up. Of the 115 known patients treated with domperidone, 88 had idiopathic, 16 diabetic, and 9 postsurgical gastroparesis. Side effects were reported by 44 patients (most common-headache, tachycardia/palpitations, diarrhea); 14 patients stopped treatment. Hundred and one patients were seen at follow-up taking domperidone (2.4 ± 2.7 months, average dose 36 ± 13 mg/day). CPGAS averaged 2.7 ± 2.7 (p < 0.01) with 69 patients reporting symptom improvement and 45 patients at least moderately improved with CPGAS ≥ 4. Improvements were seen in most symptoms, especially postprandial fullness, nausea, vomiting, and stomach fullness. CONCLUSIONS: In this large single-center study of patients treated with domperidone, side effects necessitating discontinuing treatment occurred in 12 %. The majority of patients remaining on treatment experienced an improvement in symptoms of gastroparesis, particularly postprandial fullness, nausea, vomiting, and stomach fullness. Thus, domperidone treatment is beneficial for many patients with symptoms of gastroparesis. This study provides needed benefit and risk information concerning treating patients with domperidone. FDA IND Number: 71,089.