Variation in gastroduodenal function testing in clinical practice: Results from an international survey

  • Kindt, S. (Speaker)
  • Asma Fikree (Contributor)
  • Mark R Fox (Contributor)

Activity: Talk or presentationTalk or presentation at a conference

Description

Introduction
When endoscopy and imaging fail to identify structural abnormalities, patients with digestive symptoms after meals may be referred for further evaluation of gastroduodenal function (GDF). Different techniques are available for this assessment.

Aim
This study aims to audit the availability of these techniques in practice and to compare the standard operating procedures (SOPs), data analysis and measurements.

Methods
Members from expert centres offering GDF testing indicated the patient load, the availability and desirability of 15 different testing modalities including non-invasive imaging (e.g. scintigraphy), manometry, and full thickness biopsies) for the assessment of gastric emptying, accommodation, sensitivity or motility. For available tests, multiple-choice questions assessed the indication for referral and details on SOPs including meal type.

Results
Twenty-two respondents from 12 different countries, seeing each on average 46 [24-61] patients with suspected gastroduodenal dysfunction per month, completed the audit. Gastric emptying scintigraphy (GES) was available to 86% of respondents, nutrient drinking challenge (NDC) 50%, EndoFLIP 46%, gastric emptying breath test (GEBT) 36%, intragastric pressure measurement (IGP) 32%, antroduodenal manometry (ADM) 32%, and body surface mapping (BSM) 32%. Less than 30% of participants had access to any of the other testing modalities. Gastric MRI (50%), BSM (32%) and IGP (27%) were most desired. Testing modalities were utilised for assessing nausea/vomiting (70%) and postprandial symptoms (58%) and less frequently for epigastric pain (31%). Meal composition, either solid or liquid, and symptom assessment differed widely for the same test as well as between modalities. When performing NDC, all respondents provided a standardised liquid test meal (100%) and always assessed pain and fullness (resp. 90% and 100%). However, during GES and GEBT, resp. 64% and 50% did not record symptoms. There was also large variation in meal volume, caloric content, test duration and reference values used for the individual tests.

Conclusions
Availability, indication, data acquisition and analysis of GDF testing vary between centres. Standardisation of test methodology, and SOPs including type of test meal is required to ensure generalisability of test interpretation, communication between different sites, further research and ultimately patient benefit.
Period2 Feb 2024
Event titleBelgian Week of Gastro-enterology
Event typeConference
Degree of RecognitionNational