Novel testing of human gastric motor and sensory functions: rationale, methods, and potential applications in clinical practice

Abstract

Sensitive and reproducible tests are essential to investigate the mechanisms of gastric motility and sensation in healthy humans and patients with unexplained upper gastrointestinal symptoms. Electrogastrography, manometry, scintigraphic emptying, and barostat studies with an intragastric balloon were initially used to understand physiology and pathophysiology of gastric motility. However, manometry and barostat studies are time-consuming, costly, and invasive, thus reducing their widespread clinical application. To overcome these shortcomings, several novel approaches have been proposed: water/nutrient drink test, paracetamol absorption test, 13C-octanoic acid or spirulina breath tests, ultrasonography, magnetic resonance imaging (MRI), single photon emission computed tomography (SPECT), and tensostat. The water/nutrient (satiety) test is a noninvasive test proposed as an alternative to sensory studies performed with an intragastric balloon. The satiety test cannot measure gastric accommodation; interpretation of sensory tests usually has required independent assessment of accommodation or compliance. The tensostat can be used as a gastric sensation test because it measures gastric wall tension, which is related to the perception of gastric distention. To measure gastric emptying, the paracetamol absorption test, 13C breath tests, ultrasound, or MRI can be used. The paracetamol absorption test can measure the gastric emptying of liquids. 13C breath test can measure the gastric emptying of solids or liquids and can achieve accuracy comparable with gastric scintigraphy. Ultrasonography requires special skills, and MRI requires costly equipment. To measure gastric accommodation to a meal, ultrasound, MRI, and SPECT have been proposed. The recently introduced SPECT requires an intravenous injection of 99mTc-pertechnetate, which the gastric mucosa specifically takes up, and specialized imaging and analysis, which have potential to be automated. Thus, novel, noninvasive approaches assess different dimensions of gastric motility and sensation testing. With further development of these techniques, refinement of their conduct and analysis, and validation of clinical usefulness, they are likely to be applicable in clinical practice to enhance cost-effective, evidence-based management of upper gastrointestinal symptoms. Such applications may provide an alternative to sequential empirical trials for symptoms.