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. 2022 Jul 1;323(1):G44-G59.
doi: 10.1152/ajpgi.00278.2021. Epub 2022 May 3.

Postprandial symptoms in patients with symptoms of gastroparesis: roles of gastric emptying and accommodation

Henry P Parkman  1 , Mark L Van Natta  2 , Alan H Maurer  1 , Kenneth L Koch  3 , Madhusudan Grover  4 , Zubair Malik  1 , Irene Sarosiek  5 , Thomas L Abell  6 , Robert Bulat  2 , Braden Kuo  7 , Robert J Shulman  8 , Gianrico Farrugia  4 , Laura Miriel  2 , James Tonascia  2 , Frank Hamilton  9 , Pankaj J Pasricha  2 , Richard W McCallum  5
Affiliations

Postprandial symptoms in patients with symptoms of gastroparesis: roles of gastric emptying and accommodation

Henry P Parkman et al. Am J Physiol Gastrointest Liver Physiol. .

Abstract

Patients often are evaluated for gastroparesis because of symptoms occurring with meals. Gastric emptying scintigraphy (GES) is used for gastroparesis diagnosis, although results are not well correlated with gastroparesis symptoms. The aim of this study is to assess relationships between gastroparesis symptoms, gastric emptying (GE), and gastric accommodation (GA). Patients with symptoms of gastroparesis completed the Patient Assessment of Upper GI Symptoms (PAGI-SYM) and recorded symptoms during GES and water load satiety test (WLST), an indirect assessment for GA. A total of 109 patients with gastroparesis symptoms were assessed. Symptom severity increased after GES meal for stomach fullness, belching, nausea, abdominal burning, and abdominal pain. There was no difference in symptoms after meal between patients with delayed (n = 66) and normal (n = 42) GE. Diabetic patients (n = 26) had greater gastric retention than idiopathic patients (n = 78), but idiopathic patients had greater postprandial nausea, stomach fullness, and abdominal pain. Water consumed during WLST averaged 421 ± 245 mL. Idiopathic patients had greater nausea scores during WLST than diabetic patients. In comparison to those with normal water consumption (≥238 mL; n = 80), patients with impaired water ingestion (<238 mL; n = 26) had increased stomach fullness, early satiety, postprandial fullness, and loss of appetite on PAGI-SYM. Patients with delayed and normal GE had similar symptom profiles during GES and WLST. Idiopathic patients had less gastric retention but more symptoms after GES meal and after WLST compared with diabetic patients. Patients with impaired water consumption during WLST had increased symptoms by PAGI-SYM. These data suggest that impaired GA, rather than GE, may be important in explaining postprandial symptoms in patients with symptoms of gastroparesis.NEW & NOTEWORTHY Patients with delayed and normal gastric emptying (GE) had similar symptom profiles during gastric emptying scintigraphy (GES). Idiopathic patients with symptoms of gastroparesis had less gastric retention by GES; but more symptoms after GES meal and after water load satiety test (WLST) compared with diabetic patients. In patients with symptoms of gastroparesis, symptoms after WLST increased with decreasing water consumption. Early satiety and loss of appetite were associated with decreased water consumption during WLST. Thus, impaired accommodation and perhaps visceral hypersensitivity are important in explaining postprandial symptoms in gastroparesis.

Trial registration: ClinicalTrials.gov NCT01696747.

Keywords: gastric accommodation; gastric emptying; gastroparesis.

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Conflict of interest statement

No conflicts of interest, financial or otherwise, are declared by the authors.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Symptoms during gastric emptying scintigraphy (GES) for patients with normal gastric emptying and delayed gastric emptying. Symptoms increased postprandially for both normal gastric emptying and delayed gastric emptying, with similar symptoms between the 2 groups of patients. P values for normal vs. delayed gastric emptying are below each graph. CI, confidence interval.
Figure 2.
Figure 2.
Symptoms during gastric emptying scintigraphy (GES) for patients with idiopathic and diabetic etiologies. Symptoms were more severe in the idiopathic group for abdominal pain (P = 0.007) and stomach fullness (P = 0.05). The results are displayed as mean with the 95% confidence interval (CI). P values for normal vs. delayed gastric emptying are depicted under each graph, calculated with Wald’s test based on random-effects models regressing change in symptom score on group status, time, and pretest symptom score.
Figure. 3.
Figure. 3.
Symptoms during water load satiety test (WLST) compared for patients with normal vs. impaired water load ingestion (A) and normal vs. delayed gastric emptying (B). There were no differences in the symptoms during WLST for either type of group. P values for normal vs. low water consumption are below the graphs in A P values for normal vs. delayed gastric emptying are below the graphs in B. GES, gastric emptying scintigraphy.
Figure 4.
Figure 4.
Symptoms of the Patient Assessment of Upper GI Symptoms (PAGI-SYM) compared for normal and delayed gastric emptying patients (A) and normal water load ingestion and impaired water load ingestion (B). A: there were no significant differences in the PAGI-SYM severities between patients with normal gastric emptying (NGE) and delayed gastric emptying (Gp). B: there were increases in the early satiety/postprandial fullness subscore in patients with low water consumption during the WLST suggesting impaired accommodation. *P < 0.05; **P < 0.01. GCSI, Gastroparesis Cardinal Symptom Index; VAS, visual analog scale.
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