Prokinetic therapy: what can be measured by gastric scintigraphy?
OBJECTIVE
To evaluate whether gastric scintigraphy with quantitative analysis of gastric peristalsis may be a useful tool for documenting the effects of prokinetic therapy.


METHODS
Gastric emptying was determined in eight patients with insulin dependent diabetes mellitus (IDDM) and nine patients with progressive systemic sclerosis (PSS) after ingestion of a semi-solid test meal. Fourier analysis of condensed images was used to evaluate contraction amplitudes of the entire stomach, as well as frequency and velocity of gastric contractions. Patients were studied twice, first under baseline conditions and then after 4 weeks of continuous oral prokinetic therapy with cisapride (10 mg t.i.d.). Findings were compared with data derived from 15 healthy controls.


RESULTS
At baseline conditions IDDM and PSS patients exhibited reduced gastric peristalsis and delayed emptying compared to controls. After 4 weeks of prokinetic treatment, gastric contraction amplitudes increased significantly, especially in the gastric corpus and the proximal stomach, associated with a slight improvement of gastric emptying. Changes in frequency and velocity of gastric contractions during prokinetic treatment correlated with the improvement of gastric motility and emptying.


CONCLUSIONS
Prokinetic therapy with cisapride stimulates gastric motility, and could be non-invasively monitored by scintigraphy. This radionuclide technique provides a number of relevant parameters of gastric function, such as gastric emptying, contraction amplitudes, frequency and velocity of gastric contractions, which give crucial insights into the mechanisms of action of prokinetic drugs.
Linke
Rainer
R
Department of Nuclear Medicine, University of Munich, Germany. rainer.linke@med.uni-muenchen.de
Meier
Matthias
M
Muenzing
Wolfgang
W
Folwaczny
Christian
C
Schnell
Oliver
O
Tatsch
Klaus
K
D000328:Adult; D000368:Aged; D020117:Cisapride / Q000008:administration & dosage*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D005260:Female; D005746:Gastric Emptying / Q000187:drug effects*; D005765:Gastrointestinal Agents / Q000008:administration & dosage; D018589:Gastroparesis / Q000000981:diagnostic imaging* / Q000188:drug therapy* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011379:Prognosis; D011877:Radionuclide Imaging; D045743:Scleroderma, Diffuse / Q000150:complications* / Q000000981:diagnostic imaging* / Q000188:drug therapy; D016896:Treatment Outcome
D005765:Gastrointestinal Agents; D020117:Cisapride