Antroduodenal motility recording identifies characteristic patterns in gastroparesis related to underlying etiology

Abstract

Background: Gastroparesis (GP) is a gastrointestinal disorder associated with significant morbidity and healthcare costs. GP patients form a heterogeneous population with diverse etiology, and treatment is often challenging due to a poorly understood underlying pathophysiology. The aim of the present study was to assess antroduodenal motility patterns among the different GP etiologies.

Methods: We reviewed antroduodenal manometry (ADM) recordings of patients with confirmed GP between 2009 and 2019. ADM measurements were evaluated for fed period duration, number of phase III contractions and migrating motor complexes (MMCs), motility index (MI), and presence of neuropathic patterns.

Key results: A total of 167 GP patients (142 women, median age 45 [31-57]) were included. The following etiologies were identified: idiopathic n = 101; post-surgery n = 36; and diabetes n = 30. Fed period duration was significantly longer in idiopathic (p < 0.01) and diabetic GP patients (p < 0.05) compared with post-surgery GP patients. Furthermore, the number and duration of phase III contractions and the number of MMCs were significantly lower in idiopathic and diabetic patients compared with post-surgery GP patients (p < 0.01). Likewise, absence of MMCs during 6-h recording was more often observed in idiopathic and diabetes GP patients compared with post-surgery GP patients (resp. p < 0.01 and p < 0.05).

Conclusions and inferences: Antroduodenal motility patterns are different among GP etiologies. A dysmotility spectrum was identified with different patterns ranging from post-surgery GP to idiopathic and diabetic GP.

Keywords: antroduodenal manometry; gastrointestinal motility; gastroparesis; migrating motor complex.

FIGURE 1

Flow chart of inclusion process. ADM, antroduodenal manometry; GE, gastric emptying; GP, gastroparesis; n, number of included patients

FIGURE 2

Kaplan–Meier curves of fed period duration (in minutes) in: (A) Post‐surgery, idiopathic, and diabetic gastroparesis patients. The p‐value represents the statistical difference between the curves which was calculated by log rank test and a multivariable Cox regression model to adjust for potential confounding by gender, age, BMI, clinical severity and gastric half emptying time (GE T _1/2). (B) Idiopathic GP patients according to clinical severity grades of gastroparesis (defined as grade 1—mild symptoms, grade 2—moderate symptoms, grade 3—refractory symptoms); (C) Idiopathic GP patients according to severity of gastric half emptying time (defined as GE T _1/2 < 180 min, GE T _1/2 181–250 min and GE T _1/2 > 250 min)

FIGURE 3

(A) Distribution of the observed number of migrating motor complexes (MMCs) during 6‐h antroduodenal manometry among post‐surgery, idiopathic, and diabetic gastroparesis patients. (B) Distribution of the observed number of migrating phase III contractions during 6‐h antroduodenal manometry among post‐surgery, idiopathic, and diabetic gastroparesis. Both figures correspond with count data. The green line represents the median number within each group. Adjusted p‐values were assessed using a generalized linear model with log link fit

FIGURE 4

Proportional absence of migrating motor complexes (MMCs) for the percentage of patients within post‐surgery, idiopathic, and diabetic gastroparesis as assessed by chi‐square Fisher’s exact test

FIGURE 5

(A) Antral motility index (MI) of post‐surgery, idiopathic, and diabetic gastroparesis patients; (B) Duodenal motility index (MI) of post‐surgery, idiopathic, and diabetic gastroparesis patients. The green line represents the mean motility index within each group. The dotted line represents the cutoff point for antral hypomotility