title: Development and validation of a large, modular test meal with liquid and solid components for assessment of gastric motor and sensory function by non-invasive imaging.
abstract: BACKGROUND
  Current investigations of stomach function are based on small test meals that do not reliably induce symptoms and analysis techniques that rarely detect clinically relevant dysfunction. This study introduces the large 'Nottingham Test Meal' (NTM) for assessment of gastric motor and sensory function by non-invasive imaging.
  
  
  METHODS
  NTM comprises 400 mL liquid nutrient (0.75 kcal/mL) and 12 solid agar-beads (0 kcal) with known breaking strength. Gastric fullness and dyspeptic sensations were documented by 100 mm visual analogue scale (VAS). Gastric emptying (GE) were measured in 24 healthy volunteers (HVs) by gastric scintigraphy (GS) and magnetic resonance imaging (MRI). The contribution of secretion to gastric volume was assessed. Parameters that describe GE were calculated from validated models. Inter-observer agreement and reproducibility were assessed.
  
  
  RESULTS
  NTM produced moderate fullness (VAS ≥30) but no more than mild dyspeptic symptoms (VAS <30) in 24 HVs. Stable binding of meal components to labels in gastric conditions was confirmed. Distinct early and late-phase GE were detected by both modalities. Liquid GE half-time was median 49 (95% CI: 36-62) min and 68 (57-71) min for GS and MRI, respectively. Differences between GS and MRI measurements were explained by the contribution of gastric secretion. Breaking strength for agar-beads was 0.8 N/m(2) such that median 25 (8-50) % intact agar-beads and 65 (47-74) % solid material remained at 120 min on MRI and GS, respectively. Good reproducibility for liquid GE parameters was present and GE was not altered by agar-beads.
  
  
  CONCLUSIONS
  The NTM provided an objective assessment of gastric motor and sensory function. The results were reproducible and liquid emptying was not affected by non-nutrient agar-beads. The method is potentially suitable for clinical practice.
authors: NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.|Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.
authors: H L
authors: HL
authors: Parker
authors: NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.
authors: E
authors: E
authors: Tucker
authors: NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.|Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.
authors: C L
authors: CL
authors: Hoad
authors: Department of Biological Sciences and Bioengineering, Indian Institute of Technology, Kanpur, India.
authors: A
authors: A
authors: Pal
authors: Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.
authors: C
authors: C
authors: Costigan
authors: NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.
authors: N
authors: N
authors: Hudders
authors: Radiological Sciences, School of Medicine, University of Nottingham, Nottingham, UK.|Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors: A
authors: A
authors: Perkins
authors: Medical Physics and Clinical Engineering, Nottingham University Hospitals NHS Trust, Nottingham, UK.
authors: E
authors: E
authors: Blackshaw
authors: Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.
authors: P
authors: P
authors: Gowland
authors: NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.|Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.
authors: L
authors: L
authors: Marciani
authors: NIHR Nottingham Digestive Diseases Biomedical Research Unit and Nottingham Digestive Diseases Centre, School of Medicine, Nottingham University Hospital, University of Nottingham, Nottingham, UK.|Zürich Neurogastroenterology and Motility Research Group, Department of Gastroenterology and Hepatology, University Hospital Zürich, Zürich, Switzerland.|Department of Gastroenterology, St. Claraspital, Basel, Switzerland.
authors: M R
authors: MR
authors: Fox
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D005762:Gastroenterology / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011877:Radionuclide Imaging; D015203:Reproducibility of Results; D013272:Stomach Diseases / Q000175:diagnosis*; D055815:Young Adult
keywords: gastric emptying; magnetic resonance imaging; scintigraphy; visceral sensitivity