Assessment of Gastro-Intestinal Function to a Mixed Meal by Non-invasive Imaging

Study Overview
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Brief Summary
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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.

Official Title
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Pilot Study: Assessment of Gastric Motor and Sensory Function to a Mixed Liquid and Solid Test Meal by Gamma Scintigraphy, Magnetic Resonance Imaging and a Nutrient Drink Test in Health and Patients With Disorders of Gastric Function

Conditions
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Functional Dyspepsia, Diabetic Gastroparesis

Intervention / Treatment
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* Other: Magnetic Resonance Imaging MRI
* Other: Gamma Scintigraphy
* Procedure: Assessment of Gastric motor and sensory function


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Be an adult patient above 18 years old Have a body mass index of >18 and <30kg.m2 and not exceed a waist circumference of 99cm at 5cm above ileal crest Be able to give voluntary informed consent and from whom written consent to participate has been obtained. Be able to understand the study, willing to co-operate with the study procedures and able to attend all study assessments. Be willing to abstain from alcohol for 24 hours before and during the imaging appointment. Be willing to fast from midnight prior to the screening and imaging appointment 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) Be able to swallow a solid agar bead between 7.5 and 11.5 mm in diameter Be willing to consent to their General Practitioner (GP) being informed of their participation. Exclusion Criteria: Have a history of gastrointestinal disease or surgery (other than appendicitis or hysterectomy) Have ongoing disease requiring active management (including impaired renal clearance GFR <50 mL/min/1.73 m2) Have a documented history of alcohol or drug abuse Fail to satisfy the investigator's assessment of fitness to participate based on a survey of inclusion and exclusion criteria Have consumed alcohol within 24 hours of start of study Have participated in a similar study involving the use of radioisotopes in the previous 3 months such that participating in the current study would exceed the recommended yearly exposure limit (5mSv) Take any medication which may affect oesophageal or gastric motility for a minimum 7 days Have had previous history of gastric surgery Have active upper gastrointestinal diseases Have an active Eating Disorder Have an allergy to milk protein (milk based, lactose free test meal) Be a vegan Be pregnant or breastfeeding Have any contraindication to MRI scanning according to local guidelines

Ages Eligible for Study
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Minimum Age: 18 Years
Maximum Age: 80 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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Accepts Healthy Volunteers

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Diagnostic
Intervention Model: Single Group Assignment
Masking: None (Open Label)


Arms and Interventions

| Intervention/Treatment |
| --- |
|Other: Magnetic 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.|
|Other: Gamma Scintigraphy|400ml of milkshake and 12 agar beads are ingested and gamma scintigraphy scanning completed to document gastric emptying and outcome measures listed earlier.|
|Procedure: Assessment of Gastric motor and sensory function|nan|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Maximum volume ingested at nutrient drink test (ml) | Maximum of milkshake ingested at maximum satiety | Study Day | 
| Gastric emptying rate (ml/min) for liquids | gastric emptying rate measured by non-invasive imaging | Study day | 
| Gastric emptying rate (ml/min) for solids | Gastric emptying rate measured by non-invasive imaging | Study Day | 
| Time taken for 50% gastric emptying (T50, minutes) for liquids | time taken for 50% of gastric contents to leave the stomach | Study day-After 50% of contents of stomach has emptied | 
| Time take for 50% gastric emptying (T50, minutes) solids | Time taken for 50% of gastric contents to leave the stomach | Study day-after 50% of contents of stomach has emptied | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Sensation at 200ml, 400ml and at completion of nutrient drink test (fullness, bloating, nausea, heartburn, epigastric pain) | Visual analogue score for each sensation (score up to 100 points) | Study day | 
| Glycaemic response at 15 minutes and 30 minutes post 400ml milkshake | Blood glucose (mmol/l) | study day | 
| Gastric volume at 200ml nutrient ingestion | Measurement of gastric volume (ml) on MRI and gamma scintigraphy | Study day | 
| Gastric volume at 400ml nutrient ingestion | measurement of gastric volume (ml) on MRI and gamma scintography | study day | 
| Gastric contractile wave contractile frequency | contractile frequency within stomach | study day | 
| Oro-caecal Transit time | Time taken for 50% gastric contents to enter caecum | study day | 
| Sensation threshold volume for fullness, bloating, nausea, heartburn and epigastric pain | Gastric volume recorded at time of maximum symptom scores | study day | 
| Sensation at 200ml and 400ml ingestion of test meal (fullness, bloating, nausea, heartburn, epigastric pain) | Visual analogue score for each sensation (score up to 100 points) | study day | 
| GI Hormone Assessment | 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. | Study day |