Dyspepsia is as unpleasant as it sounds. This condition of nausea, bloating, abdominal pain, heartburn and belching accounts for 3 to 4 percent of visits to family physicians, and nearly a third of all gastroenterology consultations. But now, if "my doctor says Mylanta" doesnít seem to help, the uncomfortable patient has a new and more bearable choice in diagnostic tests.
Instead of swallowing a chalky barium beverage for an upper gastrointestinal (GI) series, a dyspepsia sufferer can eat a scrambled-egg sandwich and have a gamma camera trace the snackís journey through the digestive tract. The test, called an isotopic radiogastrogram, records the pattern of the stomachís rhythmic contractions, which is converted into an image. A sluggish or out-of-sync stomach could explain the symptoms.
Isotopic radiogastrograms are performed only at the Temple University Health Sciences Center in Philadelphia. The test provides a different and perhaps more complete picture of stomach rumblings by zeroing in on the "stomachbeat."
The entire gastrointestinal tract rhythmically contracts, a process called peristalsis. The purpose is to propel digested food into the intestine. The stomach is a J-shaped pouch that holds food for about three hours. It churns to continue the mechanical digestion begun in the mouth, and secretes digestive juices that begin the chemical breakdown of nutrients. The beat keeps it all going, and determines how quickly food passes to the next stop in the gastrointestinal tract, the small intestine.
"Many people do not realize that the stomach beats approximately three times a minute. This beating is similar to how the heart beats and is critical to digestion," says Jean Luc Urbain, associate professor of diagnostic imaging at Temple and inventor of the technology. He compares the isotopic radiogastrogramís value over other techniques to the more complete picture that a video camera provides compared to a still photograph. "The procedure offers a more realistic image of the stomach by allowing us to view it digesting and emptying food," he says.
Urbain was inspired to develop isotopic radiogastrography while serving as a research fellow at Temple University from 1986 to 1987. "My background was in internal medicine, especially cardiology. I realized the stomach beating was analogous to the heartbeat, and I got the idea to look in the stomach for that," Urbain explains.
The isotopic radiogastrogram begins with the patient eating an egg sandwich. But this isnít an ordinary snackñthe eggís protein is labeled with a low-dose radioactive tracer, technetium-99m. The patient then stands between the dual heads of a gamma camera, which traces the eggís journey through the digestive tract.
The camera images the stomach in action in a series of 240 one-second shots taken every ten minutes, and the imaging continues until approximately half of the sandwich is on its way to the small intestine. The total radiation dose is less than that of a chest x-ray.
A computer then assembles the information on the rate, frequency and amplitude of the stomachís contractions into a view of the stomach in action. The stomachís beat might be too slow, too weak, or irregularñjust like an abnormal heart beat. In fact, some researchers are working on a pacemaker of sorts to control the stomachís beat, just as a cardiac pacemaker controls heartbeat.
By evaluating the pattern of stomach contractions, a physician can often pinpoint the cause of the dyspepsia, then prescribe appropriate treatment. "There are a few medications which normalize the beat of the stomach," says Urbain.
The procedure will also be useful in testing new drugs, Urbain predicts. Possible new treatments for dyspepsia could be evaluated according to how they affect the stomachbeat, rather than solely by patient reports of pain alleviation. This would enable researchers to assess whether a potential new drug targets the problem at its source.
Isotopic radiogastrography is approved by the US Food and Drug Administration and has been offered at Temple since 1993. The cost of the procedure is about $250. Urbain predicts that the approach will revolutionize the diagnosis and treatment of dyspepsia.
By Dr. Ricki Lewis
Contributing Editor
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