Internal Medicine News - One-step test for gastroparesis guides metoclopramide use
Los ANGELES — A one-step procedure can be used to diagnose gastroparesis and identify the best candidates for metoclopramide therapy.
The determination is based on gastric emptying time, which can be calculated by feeding patients scrambled eggs laced with a radioactive tracer. Scintigraphy is then used to observe and quantify the passage of the eggs through the stomach.
The process can be used to measure gastric emptying halftime and determine if the patient has gastroparesis. The response to a dose of metoclopramide (Reglan) also can be evaluated, Dr. Amolak Singh reported at the annual meeting of the Society of Nuclear Medicine.
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Dr. Singh and his associates at the University of Missouri-Columbia have used this technique on 750 patients and have diagnosed gastroparesis–defined as a gastric emptying half-time of over 100 minutes-in 168.
After measuring each patient’s baseline gastric emptying halftime, they administered a 10-mg IV dose of metoclopramide and measured the gastric emptying half-time again. The mean gastric emptying half-time went from 348 minutes to 104 minutes, with 81% of patients experiencing more than a 50% decrease in gastric emptying half-time following the metoclopramide injection.
The overall response to metoclopramide was excellent in men and women, but men had a slightly better response, Dr. Singh reported.
A poor response, defined as a gastric emptying half-time decrease of less than 34%, was noted in 16% of the patients.
These patients were not considered candidates for metoclopramide therapy.
Dr. Singh suggested a gastric emptying half-time reduction of 50% or more as the guiding criterion for determining whether a patient is likely to have a good response to treatment with metoclopramide.
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