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Comparing Two Diagnostic Tools for Upper Gastroenterology Symptoms

Comparing Two Diagnostic Tools for Upper Gastroenterology Symptoms 1024 680 Pam Georgiana
Close up color photo of little boy holding hands on his belly

A retrospective analysis of the clinical correlation between gastric emptying scintigraphy and antroduodenal manometry in pediatric patients with upper GI symptoms.

Children with persistent nausea, vomiting or abdominal pain often undergo extensive testing to evaluate for underlying etiologies such as pediatric intestinal pseudo-obstruction, rumination or gastroparesis. Two primary diagnostic tools, gastric emptying scintigraphy (GES) and antroduodenal manometry (ADM), are commonly used to assess upper gastrointestinal function. GES measures the rate at which food empties the stomach, while ADM evaluates nerve coordination and muscle activity in the stomach and small intestine. Both are resource-intensive procedures that require time, expertise and expense.

Although ADM and GES are often used in the same patients, these tests and their results have never been directly compared in children. It is unclear whether GES and ADM provide overlapping information or complementary insights into gastrointestinal motility. While GES is more widely available and noninvasive, it can be an invalid result if the patient vomits or is unable to eat a full meal. ADM, although more detailed, is invasive and limited to specialized centers. A better understanding of the correlation between these two tests could simplify diagnostic pathways, reduce testing burden and enhance clinical decision-making.

“In our clinic, we often perform both GES and ADM in complex cases,” says Raul Sanchez, MD, attending pediatric neurogastroenterologist and member of the Motility Center at Nationwide Children’s Hospital. “We wanted to know if these tests tell us the same story, or do they capture different aspects of gastrointestinal disease?”

To answer this question, Dr. Sanchez and colleagues conducted a single-center retrospective study evaluating whether delayed gastric emptying on GES correlates with decreased stomach and intestinal muscle motility on ADM in pediatric patients. The findings were published in the Journal of Neurogastroenterology and Motility.

The team reviewed data from 64 children who underwent both GES and ADM between 2011 and 2020. Researchers divided patients into two groups based on their GES results: those with delayed gastric emptying (more than 10% retention at 4 hours) and those with normal gastric emptying. They matched patients by age, sex and body mass index (BMI). The median age was 13 years. Strict inclusion criteria excluded over 70% of initially eligible patients, mainly due to vomiting during GES, failure to eat the necessary amount of a standard meal for GES, or incomplete manometry data.

“We cannot measure stomach emptying accurately if a patient does not eat the standard meal or vomits during a GES test,” Dr. Sanchez explains. “We excluded those patients to keep the data uniform and clean.”

Children with delayed gastric emptying demonstrated significantly weaker and less frequent contractions in the stomach antrum after eating during the ADM testing compared to children whose stomachs emptied normally. In some children with delayed gastric emptying, muscle activity moved food in the wrong direction or skipped the stomach entirely when the ADM testing was analyzed.

“These findings suggest that children with delayed emptying often have weakened or compromised gastric contractions, especially after meals,” Dr. Sanchez, who is also an assistant professor of Clinical Pediatrics at The Ohio State University College of Medicine, explains.

The researchers concluded that ADM provides richer data and is better suited for GI patients with vomiting symptoms. However, GES can still be a valuable screening test in pediatric patients with significant upper GI symptoms, especially in centers without access to manometry.

“If a child cannot complete the GES due to symptoms, ADM offers the information needed to guide care even if vomiting occurs during the testing,” Dr. Sanchez says. “In some patients, it may even be the preferred initial test.”

While Dr. Sanchez concludes that further prospective research on these diagnostic tests is needed to determine if they reliably predict clinical outcomes, this study is a good first step in that direction.

 

Reference:

Sanchez RE, Reichard E, Bobbey A, Puri NB, Lu PL, Yacob D, Di Lorenzo C, Williams K, Vaz KKH. Delayed Gastric Emptying Correlates With Decreased Post-prandial Motility in Children: A Single-center Retrospective Review. Journal of Neurogastroenterology and Motility. 2025 Jan 31;31(1):102-109.

Image credit: Adobe Stock

About the author

Pam Georgiana is a brand marketing professional and writer located in Bexley, Ohio. She believes that words bind us together as humans and that the best stories remind us of our humanity. She specialized in telling engaging stories for healthcare, B2B services, and nonprofits using classic storytelling techniques. Pam has earned an MBA in Marketing from Capital University in Columbus, Ohio.

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