Determinants of symptom pattern in idiopathic severely delayed gastric emptying: gastric emptying rate or proximal stomach dysfunction?

Abstract

Background: Idiopathic gastroparesis is a syndrome characterised by severely delayed gastric emptying of solids without an obvious underlying organic cause. Although delayed gastric emptying is traditionally considered the mechanism underlying the symptoms in these patients, poor correlations with symptom severity have been reported. Aims: To investigate proximal stomach function and to study the correlation of delayed gastric emptying and proximal stomach dysfunction with symptom pattern and severity in idiopathic gastroparesis. Methods: 58 consecutive patients (19 men, mean (standard deviation) age 41 (2) years) with severely delayed solid gastric emptying (gastric half-emptying time (t 1/2 ).109 min) without an organic cause were recruited. They filled out a symptom-severity questionnaire and underwent a gastric barostat study for assessment of gastric sensitivity and accommodation. Correlation of these mechanisms with symptom pattern and overall symptom severity (sum of individual symptoms) was analysed. Results: At two different cut-off levels for gastric emptying (upper limit of normal t 1/2 up to 1.5 and 2 times), no significant change in symptom pattern occurred. 25 (43%) patients had impaired accommodation, and this was associated with higher prevalence of early satiety (p,0.005) and weight loss (p = 0.009). 17 (29%) patients had hypersensitivity to gastric distension, and this was associated with higher prevalences of epigastric pain (p = 0.005), early satiety (p = 0.04) and weight loss (p,0.005). Overall symptom severity was not correlated with gastric emptying or accommodation, but only with sensitivity to gastric distension (R = 20.3898, p = 0.003) and body weight (R = 20.4233, p = 0.001). Conclusions: In patients with idiopathic gastroparesis, the symptom pattern is determined by proximal stomach dysfunction rather than by the severity of delayed emptying.

Prokinetic effects of mirtazapine on gastrointestinal transit

“…Treatment options for FD and gastroparesis are very limited. Although prokinetics stimulate peristalsis and improve gastric pump functions by enhancing antral contractility, electrical rhythm, and/or antroduodenal coordination, sometimes they do not result in significant symptom improvement (27,34). This is because patients with delayed gastric emptying often have impaired gastric accommodation and/or visceral hypersensitivity.…”

“…Prokinetics are the first-line medicine for treating delayed gastric emptying. However, there is a poor correlation between the acceleration of gastric emptying and the improvement of gastric symptoms with prokinetics (27).…”

Relationship between Symptoms and Gastric Emptying of Solids in Functional Dyspepsia

“…Correlations were also found between visceral hypersensitivity of the proximal stomach to mechanical distension and epigastric pain, early satiety and weight loss. 24 The study concluded that the pattern of functional dyspepsia symptoms was determined by sensitivity and accommodation of the proximal stomach, rather than by the severity of delayed gastric emptying. 24 Inconsistencies among previous studies 6,8,17,24 might be due to differences in Delayed proximal GE…”

“…6,8,17,24,26 Few studies have dealt with the relationship between gastric solid emptying of the proximal stomach and symptoms. In a study that compared food distribution in the stomachs of healthy subjects and patients with functional dyspepsia, postprandial fullness was found to be related to food retention in the proximal stomach late after meal ingestion.…”

Consensus Recommendations for Gastric Emptying Scintigraphy: A Joint Report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine

“…Routine GE imaging can be used to measure both regional and total GE. Visual inspection of fundal and antral GE and quantification of regional emptying with fundic and antral regions of interest can be helpful for defining abnormal physiology and explaining dyspeptic symptoms, especially when global GE values are normal (56)(57)(58)(59). Studies have shown an association between symptoms of nausea, early satiety, abdominal distention, and acid reflux and proximal gastric retention; whereas vomiting is associated more with delayed distal GE (57).…”