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. 2025 Sep 15;25(1):640.
doi: 10.1186/s12876-025-03977-x.

Clinical insights into diabetic gastroparesis: gastric scintigraphy-based diagnosis and treatment outcomes

Mohamed-Naguib Wifi  1 , Mohamed El-Sherbiny  1 , Rasha Sobh Mohamed  2 , Ahmed Kandeel  3 , Sobhi Eid Rizk  4
Affiliations

Clinical insights into diabetic gastroparesis: gastric scintigraphy-based diagnosis and treatment outcomes

Mohamed-Naguib Wifi et al. BMC Gastroenterol. .

Abstract

Background: Long-standing diabetes mellitus (DM) can lead to macrovascular and microvascular complications, including autonomic neuropathy, which disrupts gut motility. Gastroparesis (GP) is defined as delayed gastric emptying of solids (with or without liquids) in the absence of any mechanical obstruction. The gold standard test for diagnosing gastroparesis is gastric scintigraphy (GS) using a solid meal. Gastroparesis poses diagnostic and therapeutic challenges, and can significantly impact patients with DM. The purpose of this study is to evaluate the prevalence of gastroparesis among symptomatic patients and assess treatment outcomes, with particular focus on identifying clinical predictors of delayed gastric emptying and factors associated with response to medical therapy in confirmed cases.

Patients and methods: From June 2022 to June 2024, all patients visiting the diabetes clinic in Cairo University Hospital for any reason were screened for symptoms of gastroparesis using the gastroparesis cardinal symptom index (GCSI). Symptomatic patients underwent solid gastric scintigraphy. Those diagnosed with GP were treated for three months and refractory cases were offered G-POEM.

Results: Thirty-two patients with moderate-to-severe symptoms of gastroparesis were the population of this study. Of these, 62.5% had delayed gastric emptying on solid gastric scintigraphy. A GCSI > 23 independently predicted delayed gastric emptying on solid gastric scintigraphy (OR 1.153, 95% CI (1.009-1.317), p = 0.036). 55% of GP patients achieved improvement in symptoms after three months of optimized medical therapy, and two out of four cases had sustained improvement for one year after G-POEM. The responders to medical treatment were significantly older, had lower GCSI and greater reduction in hemoglobin A1c (HbA1c) compared to those in the refractory group (p = 0.046, 0.012, 0.012, respectively).

Conclusion: This study highlighted the role of the GCSI in assessing and monitoring gastroparesis, particularly in resource-limited settings. Diabetic GP differs in clinical presentation and management from other types of GP. Optimizing glycemic control may contribute to symptoms improvement. Older age and lower symptoms burden at presentation may help identify patients more likely to benefit from medical therapy.

Keywords: Diabetes mellitus; G-POEM; Gastric scintigraphy; Gastroparesis.

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Conflict of interest statement

Declarations. Ethical approval: The research protocol was reviewed and approved by the Research Ethics Committee of the Faculty of Medicine, Cairo University (Code: MD-183-2022). This study was conducted according to the principles of the Declaration of Helsinki. Informed written consent was obtained from all participants. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
The severity of symptoms according to the total and the average GCSI in the GP group versus the GP-like group
Fig. 2
Fig. 2
The ROC curve for the total and the average GCSI in predicting the presence of delayed gastric emptying
Fig. 3
Fig. 3
Delayed gastric emptying (A) versus normal gastric emptying (B) in solid gastric scintigraphy
Fig. 4
Fig. 4
The correlations between Age, HbA1c reduction (%), initial total GCSI and response to medical treatment
Fig. 5
Fig. 5
Sensitivity and specificity of the initial total and average GCSI in predicting response to medical treatment
See this image and copyright information in PMC

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