How is Gastroparesis Diagnosed?
You can have me read this article to you instead of reading it yourself…
Or you can read it the old-fashioned way below…
It doesn’t do much good to talk about what gastroparesis is and what symptoms it can cause if we don’t have a way of confirming whether or not someone has it, right?
Well, that’s not exactly true, but it is helpful to understand how this condition can be diagnosed, because a diagnosis is your clearest path to understanding what is happening and how to deal with it.
There are a number of tests and studies that are conducted for people that are thought to have gastroparesis. In fact, for those of us that have already been diagnosed, we will even have some of these studies conducted multiple times. So it is very important to understand what they entail and when/why they are being completed.
I promise that the “Chelsey Take” below is quite different than what you have found elsewhere. Hopefully this whole series has been worth your reading thus far!
The Emptying Test
Most people that have a gastroparesis diagnosis have gone through everyone’s favorite test – the gastric emptying test (or officially, gastric emptying scintigraphy). This is really considered the gold standard for diagnosing gastroparesis. As you are likely familiar, the test involves the consumption of eggs and a piece of toast with jelly on it. The eggs have a radioactive substance added to them that can be scanned as it passes through the GI tract.
There are different lengths of time for this test ranging from 2 to 6 hours. Each doctor will have their own preference, but the test that is considered to be the standard is the 4-hour test.
This test is very simplistic in that it tells you how much food has emptied out of your stomach and into your small intestine in a certain length of time. This is reported in a percentage, with the normal range usually considered to be 90% of food exiting the stomach in 4 hours. Anything less than that is considered delayed, with the lower percentages indicating a more severe delay.
For instance, if 70% of the food is emptied after 4 hours, then 30% of the food is still in the stomach, and that is considered delayed.
It is interesting to point out that the severity of the delay does not always seem to be associated with the severity of symptoms. Some people with extensive delay may not feel as sick as those with more minor delays.
Upper Endoscopy
This is not really considered a diagnostic test so much as a way for the doctor to get a better understanding for the state of your upper GI tract.
With this test, the doctor will place a camera down your throat and be able to examine your esophagus and stomach. While he is doing this, he is able to:
- Visually assess motility in both of these areas
- Evaluate the condition of the sphincter at the entrance (esophageal) and exit (pyloric) of your stomach to see if they are too loose or too tight
- Look for any other concerns, such as ulcers, hernias, or blockages
- Collect a sample that allows him to test your stomach for H. pylori (an unwelcomed bacteria)
This procedure requires the use of a small amount of sedation that allows placement of the tube down your throat. Luckily that sedation also causes amnesia, so you don’t have to remember the experience once it is over. But that also means you might repeat yourself a few times as you come out of the haze!
Barium Testing
Barium is a very interesting product because even though it is used for imaging, it is not actually radioactive. Instead, it is a substance that x-rays cannot pass through, which makes it stand out loud and clear on scans. In this case, it coats the walls of the GI tract, allowing the doctor to visualize the flow and shape of your GI tract.
This test can be done in different ways:
- The quickest version, the swallow test, involves simply tracing the barium down the esophagus to assess for any structural issues.
- A lengthier version is called the Upper GI Series, which involves the coating of the entire stomach. This does require some rolling and flipping, and possibly some uncomfortable placement of a pad under the stomach as needed for imaging. Finally, a doctor might be interested in seeing the passage of the barium through the small intestine. This is the longest version of the test and once the scanning of the stomach is complete, it is simply a waiting game.
This test requires you to swallow a lot of barium, which is a kind of chalky, milky substance. You may be asked to swallow effervescent barium as well, which produces a barium gas in the stomach to visualize the entire organ. As you might imagine, the production of the gas in the stomach does cause significant burping.
Both of these products may cause nausea for people with gastroparesis, but it is limited. Finally, when you pass the barium in your stool, it will appear pale and white, which can be concerning if you are not prepared for it.
Esophageal Manometry
This test involves the placement of a tube down the nose and into the esophagus and stomach. The tube is then able to evaluate the muscle contractions inside of the esophagus at various points.
The test can be more or less extensive depending on what the doctor hopes to evaluate while the tube is placed. The pressure and muscle activity can be evaluated at rest, evaluated with the consumption of food or liquids, and also evaluated in response to different medications.
The actual placement of the tube through the nose can be uncomfortable and difficult, but once it is in place, it is typically only a mild discomfort. Each person’s experience with esophageal manometry is different depending on the extent of what the doctor is planning to observe and how well you are feeling on the day it is conducted. This is a less common test to have performed and not everyone with gastroparesis will have one completed.
Other Tests
Some other tests may be conducted depending on how you contracted gastroparesis or because the doctor wants to rule out other possible causes first.
For instance, further imaging of the abdomen may be done in order to make sure that there are no issues with the pancreas or gallbladder. Blood tests may be conducted to look for underlying causes like diabetes or an underactive thyroid. Some people may even swallow something called a SmartPill that keeps data on how quickly it moves through different parts of the GI tract.
When very small children are being assessed for gastroparesis, they sometimes undergo what is called a milk scan. This is very similar to the gastric emptying test used in adults, but the radioactive tracer is added to milk instead. It allows the doctors to evaluate whether the baby has reflux and also the rate at which the milk empties through the stomach.
Alright! Now we know what gastroparesis is, what causes it, what the symptoms are, and how it is diagnosed.
Interested in more information on Gastroparesis?
Next: How is Gastroparesis Treated?
Or refer back to the Gastroparesis Info Hub.
Trivia and Terminology:
If I ever taste radioactive eggs and toast again, it will be too soon. And I haven’t been able to touch Ensure since I threw it back up during my esophageal manometry!
Gastroparesis is Greek for “partial paralysis of the stomach”
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