Use and variation in the practice of gastric and gastroduodenal function testing: results from an international...

Gastric emptying scintigraphy is the reference standard for measurement of gastric emptying; other investigations of gastroduodenal sensorimotor function (GDF) are available. This study examined variation in testing between institutions to assess the range of current practice.

A web-based questionnaire assessing availability, standard operating procedures and interpretation of 14 GDF testing techniques was distributed among clinicians with expertise in the performance of gastrointestinal motility investigations.

Fifty-seven respondents (86% tertiary care) from 28 different countries completed the survey. Availability of clinical investigations at these centres included: 100% gastroscopy, 91% measurement of gastric emptying (79% scintigraphy; 19% gastric emptying breath testing; and 5% single-photon emission computed tomography), 39% intragastric pressure measurements, 33% pyloric EndoFLIP, 30% gastric MRI, 19% nutrient drinking challenge, 18% gastric ultrasound, 18% motility capsule and 16% gastrointestinal manometry, with other techniques available to less than 15% of the respondents. Functional dyspepsia with postprandial distress and chronic nausea and vomiting were considered key indications for GDF studies as compared to epigastric pain syndrome (P < 0.001). There was heterogeneity in the type of meal used for each test as well as between tests. Approximately half the respondents recorded symptoms during tests of gastric emptying and there was variation also in the specific symptoms included in these questionnaires.

A large variation in the availability of technology, methodology, data acquisition and analysis exists for GDF investigations. This hampers clinical interpretation, data transfer between clinicians and research collaboration. These findings emphasise the need for an international cooperation to standardise procedures.