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. 2023 Nov 1;325(5):G407-G417.
doi: 10.1152/ajpgi.00065.2023. Epub 2023 Aug 8.

Relationships among intragastric meal distribution during gastric emptying scintigraphy, water consumption during water load satiety testing, and symptoms of gastroparesis

Henry P Parkman  1 , Laura A Wilson  2 , Paul Silver  1 , Alan H Maurer  1 , Irene Sarosiek  3 , Robert S Bulat  2 , Braden Kuo  4 , Madhusudan Grover  5 , Gianrico Farrugia  5 , Bruno P Chumpitazi  6 , Robert J Shulman  6 , Zubair Malik  1 , Laura A Miriel  2 , James Tonascia  2 , Frank Hamilton  7 , Thomas L Abell  8 , Pankaj J Pasricha  2 , Richard W McCallum  3 , Kenneth L Koch  9 ; NIDDK Gastroparesis Clinical Research Consortium
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Relationships among intragastric meal distribution during gastric emptying scintigraphy, water consumption during water load satiety testing, and symptoms of gastroparesis

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

Abstract

Gastric emptying scintigraphy (GES) measures total gastric retention after a solid meal and can assess intragastric meal distribution (IMD). Water load satiety test (WLST) measures gastric capacity. Both IMD immediately after meal ingestion [ratio of proximal gastric counts after meal ingestion to total gastric counts at time 0 (IMD0)] and WLST (volume of water ingested over 5 min) are indirect measures of gastric accommodation. In this study, IMD0 and WLST were compared with each other and to symptoms of gastroparesis to gauge their clinical utility for assessing patients with symptoms of gastroparesis. Patients with symptoms of gastroparesis underwent GES to obtain gastric retention and IMD0, WLST, and filled out patient assessment of upper GI symptoms. A total of 234 patients with symptoms of gastroparesis were assessed (86 patients with diabetes, 130 idiopathic, 18 postfundoplication) and 175 (75%) delayed gastric emptying. Low IMD0 <0.568 suggesting initial rapid transit to the distal stomach was present in 8% and correlated with lower gastric retention, less heartburn, and lower volumes consumed during WLST. Low WLST volume (<238 mL) was present in 20% and associated with increased severity of early satiety, postprandial fullness, loss of appetite, and nausea. Low IMD0 is associated with less gastric retention and less heartburn. Volume of water consumed during WLST, while associated with IMD0, has associations with early satiety, postprandial fullness, loss of appetite, and nausea. Thus, IMD0 and WLST appear to overlap somewhat in their assessment of gastric physiology in adults with symptoms of gastroparesis but relate to different dyspeptic symptoms.NEW & NOTEWORTHY IMD0 and WLST were assessed for their clinical utility in assessing patients with symptoms of gastroparesis. Low IMD0 is associated with less gastric retention and less heartburn. Volume of water consumed during WLST, while associated with IMD0, has associations with early satiety, postprandial fullness, loss of appetite, and nausea. IMD0 and WLST appear to overlap somewhat in their assessment of gastric physiology in adults with symptoms of gastroparesis but relate to different dyspeptic symptoms.

Keywords: early satiety; gastric emptying; gastroparesis; idiopathic gastroparesis.

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Conflict of interest statement

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

Figures

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Graphical abstract
Figure 1.
Figure 1.
Relationship of IMD0 to GES retention at 1 h postprandially (A), 2 h postprandially (B), and 4 h postprandially (C). GES, gastric emptying scintigraphy.
Figure 2.
Figure 2.
Water volume (mL) consumed during WLST by PAGI-SYM symptoms scales. Early satiety symptom scale (A); postprandial fullness symptom scale (B); loss of appetite symptom scale (C); and nausea symptom scale (D). PAGI-SYM, patient assessment of upper GI symptoms; WLST, water load satiety test.
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