Relating gastric scintigraphy and symptoms to motility capsule transit and pressure findings in suspected gastroparesis

Abstract

Background Wireless motility capsule (WMC) findings are incompletely defined in suspected gastroparesis. We aimed to characterize regional WMC transit and contractility in relation to scintigraphy, etiology, and symptoms in patients undergoing gastric emptying testing. Methods A total of 209 patients with gastroparesis symptoms at NIDDK Gastroparesis Consortium centers underwent gastric scintigraphy and WMCs on separate days to measure regional transit and contractility. Validated questionnaires quantified symptoms. Key Results Solid scintigraphy and liquid scintigraphy were delayed in 68.8% and 34.8% of patients; WMC gastric emptying times (GET) were delayed in 40.3% and showed 52.8% agreement with scintigraphy; 15.5% and 33.5% had delayed small bowel (SBTT) and colon transit (CTT) times. Transit was delayed in ≥2 regions in 23.3%. Rapid transit was rarely observed. Diabetics had slower GET but more rapid SBTT versus idiopathics (P ≤ .02). GET delays related to greater scintigraphic retention, slower SBTT, and fewer gastric contractions (P ≤ .04). Overall gastroparesis symptoms and nausea/vomiting, early satiety/fullness, bloating/distention, and upper abdominal pain subscores showed no relation to WMC transit. Upper and lower abdominal pain scores (P ≤ .03) were greater with increased colon contractions. Constipation correlated with slower CTT and higher colon contractions (P = .03). Diarrhea scores were higher with delayed SBTT and CTT (P ≤ .04). Conclusions & Inferences Wireless motility capsules define gastric emptying delays similar but not identical to scintigraphy that are more severe in diabetics and relate to reduced gastric contractility. Extragastric transit delays occur in >40% with suspected gastroparesis. Gastroparesis symptoms show little association with WMC profiles, although lower symptoms relate to small bowel or colon abnormalities.

Childhood gastroparesis is a unique entity in need of further investigation

“…An adult study led by Kuo et al showed a correlation of 0.73 and a sensitivity (0.65)/specificity (0.87) comparable to 4‐hour GES, making it a reasonable diagnostic study for GES. Conversely, a recent study led by Hasler et al demonstrated a correlation of only 53% between WMC and GES, and a lower prevalence of emptying delays with WMC when compared to GES.…”

High Prevalence of Slow Transit Constipation in Patients With Gastroparesis

“…[11][12][13] Additionally, prior studies suggest a link between gastroparesis and both esophageal dysmotility 14 and small bowel dysmotility. 15 These relationships suggest that a common pathophysiology may explain symptoms in multiple areas of the GI tract.…”

Propagation Characteristics of Fasting Duodeno-Jejunal Contractions in Healthy Controls Measured by Clustered Closely-spaced Manometric Sensors

“…However, the physiologic importance of low amplitude activity in interdigestive transit is unproved and other methods of measuring small bowel motor activity use 10 mmHg cutoffs for contractile quantifications. 36 Finally, we acknowledge the sample size of our study was small (n = 8 subjects). This sample was restricted by the parent study which was funded to evaluate ibuprofen absorption in only a limited group of healthy individuals.…”