Influence of Gastric Emptying and Gut Transit Testing on Clinical Management Decisions in Suspected Gastroparesis

Abstract

Introduction: Gastric emptying scintigraphy (GES) or wireless motility capsules (WMCs) can evaluate upper gastrointestinal symptoms in suspected gastroparesis; WMC tests can also investigate lower gut symptoms. We aimed to determine whether these tests impact treatment plans and needs for additional diagnostic evaluation.

Methods: In a prospective, multicenter study, 150 patients with gastroparesis symptoms simultaneously underwent GES and WMC testing. Based on these results, investigators devised management plans to recommend changes in medications, diet, and surgical therapies and order additional diagnostic tests.

Results: Treatment changes were recommended more often based on the WMC vs GES results (68% vs 48%) (P < 0.0001). Ordering of additional test(s) was eliminated more often with WMC vs GES (71% vs 31%) (P < 0.0001). Prokinetics (P = 0.0007) and laxatives (P < 0.0001) were recommended more often based on the WMC vs GES results. Recommendations for prokinetics and gastroparesis diets were higher and neuromodulators lower in subjects with delayed emptying on both tests (all P ≤ 0.0006). Laxatives and additional motility tests were ordered more frequently for delayed compared with normal WMC colonic transit (P ≤ 0.02). Multiple motility tests were ordered more often on the basis of GES vs WMC findings (P ≤ 0.004). Antidumping diets and transit slowing medications were more commonly recommended for rapid WMC gastric emptying (P ≤ 0.03).

Discussion: WMC transit results promote medication changes and eliminate additional diagnostic testing more often than GES because of greater detection of delayed gastric emptying and profiling the entire gastrointestinal tract in patients with gastroparesis symptoms.

Translational impact: Gastric scintigraphy and WMCs have differential impact on management decisions in suspected gastroparesis.

Trial registration: ClinicalTrials.gov NCT02022826.

Figure 1.

GES and WMC findings are shown for a subject with suspected gastroparesis. Scintigraphy images and emptying profiles of the radiolabeled meal are shown in (a). This individual exhibited mildly delayed gastric emptying at 4 hours. The WMC and tracing with the pH tracing in red, pressure tracing in blue, and temperature tracing in green are shown in (b). This subject exhibited generalized transit delays in GET, SBTT, and CTT. CTT, colon transit time; GES, gastric emptying scintigraphy; GET, gastric emptying time; SBTT, small bowel transit time; WMC, wireless motility capsule.

Figure 2.

Differential effects of GES and WMC findings on treatment recommendations in suspected gastroparesis are shown. WMC testing led to greater changes in medication therapies vs GES (a). Of the 74% of subjects with recommended medication changes, more were informed by WMC results alone compared with GES results alone (b). More than 40% of medication changes were recommended based on both abnormal GES and WMC findings. There were no differences in diet changes made in response to WMC vs GES testing. GES, gastric emptying scintigraphy; WMC, wireless motility capsule.

Figure 3.

Differential effects of GES and WMC findings on recommendations for additional diagnostic testing in suspected gastroparesis are shown. WMC testing promoted less additional test ordering and higher rates of eliminating additional testing (a). Of subjects who were recommended to undergo additional testing, fewer were referred based on WMC alone vs GES alone (b). Of those with elimination of additional testing, more tests were eliminated by WMC alone vs GES alone. More than 50% of additional diagnostic test ordering was recommended based on both abnormal GES and WMC findings. GES, gastric emptying scintigraphy; WMC, wireless motility capsule.