Development of the Nutrient Challenge Gastric Emptying Test (NCGET) - Its Role in Differentiating Between Complicated and Uncomplicated Peptic Ulcer Disease
Background: Major bleeding peptic ulcers (BPU) frequently occur without preceding symptoms and maybe due to altered visceral sensitivity. A nutrient challenge test maybe used to assess this, but the relationship between the visceral response to a nutrient challenge and gastric emptying is not known. Aims: 1) To develop a radiolabelled NCGET. 2) To simultaneously assess gastric emptying and symptom response in patients with BPU, uncomplicated peptic ulcer (uPUD) and healthy controls (HC).
Methods: We studied 10 patients with BPU (10M, mean 64yr), 10 uPUD (5M, mean 52yr), and 10 HC (7M, mean 59yr). After an 8 hr fast, subjects ingested 200 ml of a standardised oral feeding solution (Ensure®) containing 5 MBq 99mTc sulphur colloid, every 5 min up to a cumulative volume of 800 ml. Erect dynamic scintigrams were acquired for 2 hrs. Regions of interest were drawn around proximal, distal and total stomach to calculate regional retention. Symptom response was assessed by visual analogue score. Results: Patients with uPUD had greater gastric retention in the proximal stomach at 100 min than BPU (p=0.024) and HC (p=0.001) and also had increased symptom responses compared to BPU and HC. At 100 min, uPUD patients had higher retention in the total stomach than HC. (p<0.05,) Conclusions: Patients with uPUD have increased gastric retention compared to HC and BPU patients. In addition to altered gastric motor function during the NCGET, differences in visceral sensory function exist between patients with uncomplicated PUD and bleeding peptic ulcer.