Henry P. Parkman Department of Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA This questionnaire asks you about the severity of symptoms you may have related to your gastrointestinal problem. There are no right or wrong answers. Please answer each question as accurately as possible. For each symptom, please circle the number that best describes how severe the symptom has been during the past 2 weeks. If you have not experienced this symptom, circle 0. If the symptom has been very mild, circle 1. If the symptom has been mild, circle 2. If it has been moderate, circle 3. If it has been severe, circle 4. If it has been very severe, circle 5. Please be sure to answer every question. Please rate the severity of the following symptoms during the past 2 weeks. Figure 15.1 Gastroparesis Cardinal Symptom Index (GCSI). The GCSI is a nine‐symptom questionnaire that has been developed for quantifying symptoms in patients with gastroparesis. Symptom severity is graded by the patient from none to very severe over the past 2 weeks. Source: Revicki DA, Rentz AM, Dubois D, et al. Development and validation of a patient‐assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther 2003;18:141. Reproduced with permission of John Wiley & Sons. Figure 15.2 The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index Daily Diary (ANMS GCSI‐DD) Instrument. This daily questionnaire is for patients with gastroparesis to record the severity of their symptoms over the past 24 hours, usually filled out each night. This instrument is often used for assessing therapies for gastroparesis. Source: Adapted from Revicki DA, Speck RM, Lavoie S, et al. The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index‐Daily Diary (ANMS GCSI‐DD): Psychometric evaluation in patients with idiopathic or diabetic gastroparesis. Neurogastroenterol Motil 2019;31(4):e13553. Figure 15.3 Regional gastric physiology and function during gastric emptying. Gastric emptying reflects the coordinated function of the fundus, body, antrum, pylorus, and duodenum. Important events for gastric emptying include fundic relaxation and accommodation, antral contractions for trituration, pyloric opening, and overall fundic‐antral‐pyloric‐duodenal coordination. Source: Parkman HP, Jones MP. Tests of gastric neuromuscular function. Gastroenterology 2009;136:1526–43. Reproduced with permission of Elsevier. Figure 15.4 Gastric emptying scintigraphy using a technetium‐99m‐labeled egg sandwich meal which is ingested by the patient followed by imaging of the counts in the stomach over time. The percentages of gastric retention are shown for 0, 30, 60, 120, 180, and 240 min after meal ingestion. (a) Normal gastric emptying with only 30% retention at 2 h after meal ingestion (normal <60%) and complete emptying at 4 h (normal <10%). (b) Markedly delayed gastric emptying with little emptying at 4 h. Source: Courtesy of HP Parkman. Figure 15.5 Gastric emptying scintigraphy with imaging up to 4 h. Imaging for gastric emptying up to 4 h increases the detection of delayed gastric emptying. In this study, imaging up to 4 h increased the diagnostic yield for delayed gastric emptying from 31% of patients at 2 hours to 63% at 4 h. Source: Adapted from Guo JP, Maurer AH, Fisher RS, Parkman HP. Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis. Dig Dis Sci 2001;46:24–9.
CHAPTER 15
Disorders of gastric emptying
GASTROPARESIS CARDINAL SYMPTOM INDEX (GCSI)
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