Gastric motor and sensory function in health assessed by magnetic resonance imaging: Establishment of reference intervals for the Nottingham test meal in healthy subjects

Background: Current investigations of gastric emptying rarely identify the cause of symptoms or provide a definitive diagnosis in patients with dyspepsia. This study assessed gastric function by magnetic resonance imaging (MRI) using the modular "Nottingham Test Meal" (NTM) in healthy volunteers (HVs).Methods: The NTM comprises (i) 400mL liquid nutrient (0.75kcal/mL) labelled with Gadolinium DOTA and (ii) an optional solid component (12 agar-beads (0kcal)). Filling sensations were documented. MRI measurements of gastric volume, emptying, contraction wave frequency and secretion were obtained using validated methods.Key Results: Gastric function was measured in a population of 73 HVs stratified for age and sex. NTM induced moderate satiety and fullness. Labelled fluid was observed in the small bowel in all subjects after meal ingestion ("early-phase" GE). Secretion was rapid such that postprandial gastric content volume was often greater than meal volume (GCV0 >400ml) and there was increasing dilution of the meal during the study (p less than 0.001). Gastric half‐time was median 66‐minutes (95% reference interval 35 to 161‐minutes [“late‐phase” GE]). The number of intact agar beads in the stomach was 7/12 (58%) at 60‐minutes and 1/12 (8%) at 120‐minutes. Age, bodyweight and sex had measurable effects on gastric function; however, these were small compared to inter‐individual variation for most metrics.Conclusions and Inferences: Reference intervals are presented for MRI measurements of gastric function assessed for the mixed liquid/solid NTM. Studies in patients will determine which metrics are of clinical value and also whether the reference intervals presented here offer optimal diagnostic sensitivity and specificity.