Functional Dyspepsia, Diabetic Gastroparesis
Conditions
Brief summary
Dyspeptic symptoms, such as pain after eating, bloating and nausea all have major impact on quality of life and health care costs. When no structural cause is identified, patients are diagnosed with functional dyspepsia. This trial aims to identify objective abnormalities of stomach function that explain patient's symptoms and establish diagnosis. Another group are diabetic patients who can often develop similar symptoms, labelled as diabetic gastroparesis. In some cases this is associated with delayed gastric emptying but not all. 24 patients with functional dyspepsia will be studied and 24 healthy controls (to establish normal ranges) and 24 diabetic patients with symptoms of functional dyspepsia. The utility of 3 different non-invasive investigations will be assessed. At screening the nutrient drink test (NDT) asks the patient to drink 40ml of milkshake (0.75kcal/ml) every minute and score symptoms every 5 minutes. The patient continues until they reach the maximum tolerated volume. Participants will then be randomized to undergo non-invasive imaging on two separate test days by magnetic resonance imaging (MRI) and gastric scintigraphy MRI will be completed with the patient ingesting 400ml of milkshake (identical to NDT) and 12 agar beads (no additional calories) of known breaking strength. The emptying of the stomach will be visualised with the MRI alongside symptom recording. Gamma scintigraphy will ingest the same meal as for the MRI scan but radioactive labelling will allow the rate of liquid and solid meal emptying to be visualised alongside symptom recording. Additionally, blood sugars will be recorded before nutrient drink test and at 15 and 30 minutes following ingestion of 400ml of milkshake and 12 agar beads. Data will be analyzed to assess the association of objective abnormalities of gastric function and patient symptoms. Additionally the results of non-invasive imaging by MRI and GS will be compared to assess the optimal measurement of gastric function and emptying in this clinical scenario.
Interventions
OTHERMagnetic Resonance Imaging MRI
400ml of milkshake and 12 agar beads are ingested and gamma scintigraphy scanning completed to document gastric emptying and outcome measures listed earlier.
OTHERGamma Scintigraphy
400ml of milkshake and 12 agar beads are ingested and gamma scintigraphy scanning completed to document gastric emptying and outcome measures listed earlier.
PROCEDUREAssessment of Gastric motor and sensory function
Sponsors
National Institute for Health Research, United Kingdom
Nottingham University Hospitals NHS Trust
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
DIAGNOSTIC
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
Yes
Inclusion criteria
1. Be an adult patient above 18 years old 2. Have a body mass index of \>18 and \<30kg.m2 and not exceed a waist circumference of 99cm at 5cm above ileal crest 3. Be able to give voluntary informed consent and from whom written consent to participate has been obtained. 4. Be able to understand the study, willing to co-operate with the study procedures and able to attend all study assessments. 5. Be willing to abstain from alcohol for 24 hours before and during the imaging appointment. 6. Be willing to fast from midnight prior to the screening and imaging appointment 7. Be able to ingest at least 400ml nutrient liquid (0.75kcal/ml at 40ml/min) during a Nutrient Drinking Test without experiencing more than moderate dyspeptic symptoms (no such restriction for patients with dyspeptic symptoms) 8. Be able to swallow a solid agar bead between 7.5 and 11.5 mm in diameter 9. Be willing to consent to their General Practitioner (GP) being informed of their participation.
Exclusion criteria
1. Have a history of gastrointestinal disease or surgery (other than appendicitis or hysterectomy) 2. Have ongoing disease requiring active management (including impaired renal clearance GFR \<50 mL/min/1.73 m2) 3. Have a documented history of alcohol or drug abuse 4. Fail to satisfy the investigator's assessment of fitness to participate based on a survey of inclusion and
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Maximum volume ingested at nutrient drink test (ml) | Study Day | Maximum of milkshake ingested at maximum satiety |
| Gastric emptying rate (ml/min) for liquids | Study day | gastric emptying rate measured by non-invasive imaging |
| Gastric emptying rate (ml/min) for solids | Study Day | Gastric emptying rate measured by non-invasive imaging |
| Time taken for 50% gastric emptying (T50, minutes) for liquids | Study day-After 50% of contents of stomach has emptied | time taken for 50% of gastric contents to leave the stomach |
| Time take for 50% gastric emptying (T50, minutes) solids | Study day-after 50% of contents of stomach has emptied | Time taken for 50% of gastric contents to leave the stomach |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Oro-caecal Transit time | study day | Time taken for 50% gastric contents to enter caecum |
| Sensation threshold volume for fullness, bloating, nausea, heartburn and epigastric pain | study day | Gastric volume recorded at time of maximum symptom scores |
| Gastric volume at 400ml nutrient ingestion | study day | measurement of gastric volume (ml) on MRI and gamma scintography |
| GI Hormone Assessment | Study day | 5 ml of blood will be taken at time 0, 30, 60 and 120 min. GI peptide hormones will then be analysed from the samples. |
| Sensation at 200ml and 400ml ingestion of test meal (fullness, bloating, nausea, heartburn, epigastric pain) | study day | Visual analogue score for each sensation (score up to 100 points) |
| Sensation at 200ml, 400ml and at completion of nutrient drink test (fullness, bloating, nausea, heartburn, epigastric pain) | Study day | Visual analogue score for each sensation (score up to 100 points) |
| Glycaemic response at 15 minutes and 30 minutes post 400ml milkshake | study day | Blood glucose (mmol/l) |
| Gastric volume at 200ml nutrient ingestion | Study day | Measurement of gastric volume (ml) on MRI and gamma scintigraphy |
| Gastric contractile wave contractile frequency | study day | contractile frequency within stomach |
Countries
United Kingdom
Outcome results
None listed