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.

Keywords: contractility; gastric emptying; scintigraphy; small bowel and colon transit.

FIGURE 1

Representative WMC recordings from patients with (A) normal transit throughout, (B) mildly delayed GET, (C) severely delayed GET, (D) delayed CTT, and (E) generalized GET, SBTT, and CTT delays are shown (normal GET ≤5 h, normal SBTT ≤6 h, normal CTT ≤58:45 h). Transit times are calculated from pH transitions (red tracings) and temperature changes (green tracings). Pressure recordings are shown in blue

FIGURE 2

Disease etiologies were related to solid (A) and liquid (B) scintigraphic gastric emptying and WMC GET (C). Solid scintigraphic gastric retention (P = .02) and WMC GET (P = .04) values were greater among diabetic (open bars) versus idiopathic (gray bars) patients, while liquid scintigraphic emptying was not different between etiologies

FIGURE 3

Solid (A) and liquid (B) gastric emptying were compared with normal (open bars) versus delayed (gray bars) WMC GETs. Solid (P = .001) and liquid (P = .02) retentions were greater with delayed GETs. SBTT (C) and CTT (D) were compared with normal (open bars) versus delayed (gray bars) GETs. Extragastric transit was not different in relation to GET

FIGURE 4

Overall GCSI and subscale scores for nausea/vomiting (N/V), early satiety/fullness (Fullness), bloating/distention (Bloating), and upper abdominal pain/discomfort (Upper Pain) were not different with delayed versus normal GET, SBTT, or CTT (A–C). Lower abdominal pain/discomfort subscale scores (Lower Pain) were similar with delayed and normal GET, SBTT, and CTT. Constipation scores were higher with delayed CTT (P = .03); diarrhea scores were lower with delayed SBTT (P = .04) and CTT (P = .01) (D–F)