Differences between 2 and 4 hour gastric emptying study?

After being diagnosed with gastroparesis, my gastro sent me to a surgeon to discuss a gastric pacemaker. The surgeon insisted on a 4 hour gastric emptying scan as opposed to the 2 hour scan. After I was xrayed the 1st and 2nd hour of the scan, the technician told me not to even come back until the 4th hour b/c she could see that nothing was moving. When I got the results back, it basically said that things were normal and didn't even indicate that I HAVE gastroparesis. The xrays, 2 hour gastric emptying study and other tests they did in the hospital previously showed that I definitely had GP and was put on domperidone (which I wasn't able to tolerate). How could they conflict? There's a clinic in town that has something that you swallow (with a microchip inside it or something) that tests transit time. I'm wondering if I should get a second opinion as something is definitely wrong - GP or not. Anyone know why such different results? And why the tech would allow me to skip the 3rd hour of xraying? I'm severely constipated, nauseous 24/7, no appetite, feel full after a bite or 2, have lost 20+ lbs and am underweight, have abdominal pains/cramping, vomit frequently and have a distended abdomen. I'm starting to have severe anxiety over my health issues as I have a lot of autoimmune issues and they continue to get worse. I buried my head in the sand for months, just wanting to die, but since I'm still here, I need to focus on my health and stop denying that something's seriously wrong. I also fear ovarian cancer due to familial history and am going to call my ob-gyn tomorrow too. I went from not dealing with any of this to pure panic. Anyone relate?

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my 4 hr emptying test was normal also but i have all the same symptoms as you and my endoscopy showed food in my tummy 24 hrs after i ate. my gi says the ges is not reliable but my motility specialist says i'm not a candidate for pace maker due to that test. dont give up! ask for an endoscopy or other test. its real aggravating i know

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Unfortunately, the GES results can vary from test to test...sometimes our tummies just decide to kick in for the day. A doctor should look at your overall symptoms and past tests. I would definitely ask why there was a contradiction between what you were told by the tech and the results of the test. Also, during all my GES' I never left and came back for xrays. I was on the table the entire time. May want to check and see if this is proper procedure. If not, they should repeat the test.

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you should ask them to re-evaluate ... if nothing was moving at 2 hour point, how could it be normal? that doesn't make any sense. in general, GES test result could vary from day to day but it seems that something might have gone wrong with your test results ... they wrote the result backwards maybe? you should definitely talk to them again ... worst case, you should redo the test. good luck ...

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I think a lot of it has to do with where you have it done at. I am in the middle of my third one now. Normally at this hospital they only do a one hour test where you eat oatmeal with radioactive material in it and lay under the camera the entire time. My doctor requested that they also do pictures at the 4 hour mark too but the last two times I've had were at a different hospital and were totally different. The last two I had done I ate eggs with radioactive material in them then they took pictures every 30 minutes for four hours.

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I'm confused, too. No way could you have moved nothing after two hours--when 'normal' digestion would have already gone through nearly half the egg--and yet say you're normal? And yes, that tech ought to be thwapped on the forehead. No way should you have been told to leave. Those third numbers would be helpful in determining when your stomach finally began to empty. That's shoddy medicine. As to your surgery, get that surgeon on the phone. It may take hours, it may take repeated call-backs but get the actual surgeon on the phone. Make sure s/he knows about the missing third set of numbers and why they are missing. Also, ask the surgeon point-blank if not GP, then what is the cause of your ongoing symptoms. Put the situation onto the surgeon so there's no easy out to take, no way to blow off surgery because some silly number on a test report indicates 'normality'.

As if 'normal' is a term that applies to any of us anyway. Two hours of that egg sitting there? Not freaking normal.

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I am sorry to hear you went through all that. To be honest I felt confused reading it. It might be something messed up in translation, do you think? If they wanted to see you back at the 4th hour because nothing was moving, then how could the report say no GP? Like Marianne said, it can't be absolutely nothing moved after two hours and be considered normal digestion. Do you think they might put your name with someone else's report or telling you about someone else result after the first two hours? I would question that to the doctor and tell him everything you are saying here.

I had a four-hour GES too. I was told after the first hour I still had more than 90%. So I asked the technician if he thought it would make any difference in the next few hours. He said no. I asked if I could just go. He asked me to stay for another hour to take another set of pics then he left it for my decision if I wanted to stay. I did stay for the rest and tried to stay standing and leaning on the table as much as I could for the rest of the three hours hoping gravity will pull things down the track more so the report would not look as freaky...lol...my PCP laughed so hard when I told him about that! It did pull things down a little bit faster over time.

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Gravity. Our digestive aid.

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Ain't I smart, huh? The only thing I had in mind was my new GI doc would kill me. I gotta do something! I would have jumped to get it down if I could! ^_^

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And then of course there is always the possibility that some clerk somewhere mistyped a number and your file got mixed up with someone else's. Especially now since everyone is going electronic records.

I was on the phone with my GI and he suddenly said, "How old are you?" I told him 55 (at the time). He said that's what he thought, but my file showed that my age was 88. Then when I was in his office, he was looking at my chart on the computer, and there was some stuff on it that didn't belong to me- somehow it had gotten entered in my file. He simply cut and pasted it out...but still.

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Grace:

Here is some information I just read. Remembered your post and thought the info might be helpful:


Gastric Emptying Assessment

Gastric scintigraphy is the best method for diagnosing delayed gastric emptying. A 4-hour test which has the patient eat low-fat egg meals (egg substitute) is standard. Normal ranges for gastric emptying in healthy subjects at 1 hour, 2 hours and 4 hours is 90, 60 and 10 percent, respectively. Gastric retention of greater than 10 percent at 4 hours is indicative of delayed gastric emptying. Unfortunately, many centers use only a 2-hour study to save costs. In a soon-to-be-published multicenter study, we compared 2-hour and 4-hour results in patients suspected of having gastroparesis and showed that limiting the gastric emptying time to 2 hours would have missed 44 percent of patients studied who went on to have delayed gastric emptying at 4 hours (See graph). Thus, while an abnormal result at 2 hours is fairly reliable, and the test may be stopped at that point for patients with abnormal results, the study should be continued for patients with normal results for the full 4 hours.

Best Wishes :)
L

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