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Clinical Predictors of Rapid Gastric Emptying in Patients Presenting with Dyspeptic Symptoms

  • Juan Gomez CifuentesEmail author
  • Mark Radetic
  • Rocio Lopez
  • Scott Gabbard
Original Article
  • 46 Downloads

Abstract

Background

Rapid gastric emptying (RGE) is defined as less than 30% retention at 1 h of solid meal ingestion. It is unclear whether RGE represents a separated clinical entity or part of the functional dyspepsia spectrum.

Aims

To determine clinical predictors of RGE in patients presenting with dyspeptic symptoms.

Methods

Retrospective study of patients who underwent solid Gastric Emptying Scintigraphy to evaluate dyspeptic symptoms from January 2011 to September 2012. Patients with delayed gastric emptying (> 10% gastric retention at 4 h) or prior gastric surgery were excluded. Patients with RGE were compared to those with normal gastric emptying (NGE) in a patient ratio of 1:3. Demographic data, symptoms, comorbidities, surgeries, endoscopy findings, medications, HbA1c, and TSH were analyzed. Univariate and multivariate logistic regression analyses were performed.

Results

A total of 808 patients were included, 202 patients with RGE and 606 patients with NGE. Mean gastric retention at 1 h was 18% [12.0, 24.0] and 65% [52.0, 76.0], respectively. Patient with RGE were more likely to present with nausea/vomiting (OR 2.4, p < 0.001), weight loss (OR 1.7, p = 0.008), and autonomic symptoms (OR 2.8, p = 0.022). Identified clinical predictors of RGE were older age (OR 1.08 [1.01, 1.1], p = 0.018), male gender (OR 2.0 [1.4, 2.9], p ≤ <0.001), higher BMI (OR 1.03 [1.00, 1.05], p = 0.018), diabetes (OR 1.8 [1.2, 2.7], p = 0.05), and fundoplication (OR 4.3 [2.4, 7.7], p ≤ 0.001).

Conclusion

RGE represents a distinct population among patients presenting with dyspepsia in whom fundoplication, diabetes, and male gender were the strongest clinical predictors. RGE was significantly associated with nausea/vomiting, weight loss, and autonomic symptoms.

Keywords

Rapid gastric emptying Functional dyspepsia Dyspepsia Gastric emptying scintigraphy Fundoplication Diabetes mellitus 

Abbreviations

RGE

Rapid gastric emptying

NGE

Normal gastric emptying

HbA1c

Hemoglobin A1c

TSH

Thyroid-stimulating hormone

OR

Odds ratio

BMI

Body mass index

GES

Gastric emptying scintigraphy

IRB

Institutional review board

IBS

Irritable bowel syndrome

IBD

Inflammatory bowel disease

ANCOVA

Analysis of covariance

POTS

Postural orthostatic tachycardia syndrome

GERD

Gastroesophageal reflux disease

PPP

Proton pump inhibitor

TCA

Tricyclic antidepressant

Notes

Author’s contribution

JGC was involved in study concept and design; acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content. MR was involved in acquisition of data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content. RL was involved in analysis and interpretation of data; statistical analysis. SG was involved in study concept and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; study supervision.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10620_2019_5620_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)

References

  1. 1.
    Drossman DA, Hasler WL. Rome IV-functional gi disorders: disorders of gut-brain interaction. Gastroenterology. 2016;150:1257–1261.  https://doi.org/10.1053/j.gastro.2016.03.035.CrossRefGoogle Scholar
  2. 2.
    Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol. 2008;103:753–763.  https://doi.org/10.1111/j.1572-0241.2007.01636.x.CrossRefGoogle Scholar
  3. 3.
    Lindeboom MYA, Ringers J, van Rijn PJJ, Neijenhuis P, Stokkel MPM, Masclee AAM. Gastric emptying and vagus nerve function after laparoscopic partial fundoplication. Ann Surg. 2004;240:785–790. http://www.ncbi.nlm.nih.gov/pubmed/15492559.
  4. 4.
    Kusano M, Zai H, Shimoyama Y, et al. Rapid gastric emptying, rather than delayed gastric emptying, might provoke functional dyspepsia. J Gastroenterol Hepatol. 2011;26:75–78.  https://doi.org/10.1111/j.1440-1746.2011.06627.x.CrossRefGoogle Scholar
  5. 5.
    Samsom M, Bharucha A, Gerich JE, et al. Diabetes mellitus and gastric emptying: questions and issues in clinical practice. Diabetes Metab Res Rev. 2009;25:502–514.  https://doi.org/10.1002/dmrr.974.CrossRefGoogle Scholar
  6. 6.
    Lawal A, Barboi A, Krasnow A, Hellman R, Jaradeh S, Massey BT. Rapid gastric emptying is more common than gastroparesis in patients with autonomic dysfunction. Am J Gastroenterol. 2007;102:618–623.  https://doi.org/10.1111/j.1572-0241.2006.00946.x.CrossRefGoogle Scholar
  7. 7.
    Balan K, Sonoda LI, Seshadri N, Solanki C, Middleton S. Clinical significance of scintigraphic rapid gastric emptying. Nucl Med Commun. 2011;32:1185–1189.  https://doi.org/10.1097/MNM.0b013e32834bf262.CrossRefGoogle Scholar
  8. 8.
    Singh A, Gull H, Singh RJ. Clinical significance of rapid (accelerated) gastric emptying. Clin Nucl Med. 2003;28:658–662.  https://doi.org/10.1097/01.rlu.0000079390.72098.b2.Google Scholar
  9. 9.
    Lorena SL, Tinois E, Hirata ES, et al. Scintigraphic study of gastric emptying and intragastric distribution of a solid meal: gender differences. Arq Gastroenterol. 37:102–106. http://www.ncbi.nlm.nih.gov/pubmed/11144011.
  10. 10.
    Bennink R, Peeters M, Van den Maegdenbergh V, et al. Comparison of total and compartmental gastric emptying and antral motility between healthy men and women. Eur J Nucl Med. 1998;25:1293–1299. http://www.ncbi.nlm.nih.gov/pubmed/9724379.
  11. 11.
    Moore JG, Tweedy C, Christian PE, Datz FL. Effect of age on gastric emptying of liquid–solid meals in man. Dig Dis Sci. 1983;28:340–344. http://www.ncbi.nlm.nih.gov/pubmed/6831997.
  12. 12.
    Bharucha AE, Manduca A, Lake DS, et al. Gastric motor disturbances in patients with idiopathic rapid gastric emptying. Neurogastroenterol Motil. 2011;23:617–e252.  https://doi.org/10.1111/j.1365-2982.2011.01710.x.CrossRefGoogle Scholar
  13. 13.
    Cardoso-Júnior A, Coelho LGV, Savassi-Rocha PR, et al. Gastric emptying of solids and semi-solids in morbidly obese and non-obese subjects: an assessment using the 13C-octanoic acid and 13C-acetic acid breath tests. Obes Surg. 2007;17:236–241. http://www.ncbi.nlm.nih.gov/pubmed/17476878.
  14. 14.
    Vazquez Roque MI, Camilleri M, Stephens DA, et al. Gastric sensorimotor functions and hormone profile in normal weight, overweight, and obese people. Gastroenterology. 2006;131:1717–1724.  https://doi.org/10.1053/j.gastro.2006.10.025.CrossRefGoogle Scholar
  15. 15.
    Loavenbruck A, Iturrino J, Singer W, et al. Disturbances of gastrointestinal transit and autonomic functions in postural orthostatic tachycardia syndrome. Neurogastroenterol Motil. 2015;27:92–98.  https://doi.org/10.1111/nmo.12480.CrossRefGoogle Scholar
  16. 16.
    Trahair LG, Horowitz M, Jones KL. Postprandial hypotension is associated with more rapid gastric emptying in healthy older individuals. J Am Med Dir Assoc. 2015;16:521–523.  https://doi.org/10.1016/j.jamda.2015.01.097.CrossRefGoogle Scholar
  17. 17.
    Middleton SJ, Balan K. Idiopathic accelerated gastric emptying presenting in adults with post-prandial diarrhea and reactive hypoglycemia: a case series. J Med Case Rep. 2012;6:132.  https://doi.org/10.1186/1752-1947-6-132.CrossRefGoogle Scholar
  18. 18.
    Charles F, Phillips SF, Camilleri M, Thomforde GM. Rapid gastric emptying in patients with functional diarrhea. Mayo Clin Proc. 1997;72:323–328.  https://doi.org/10.1016/S0025-6196(11)63331-4.CrossRefGoogle Scholar
  19. 19.
    Bisschops R, Karamanolis G, Arts J, et al. Relationship between symptoms and ingestion of a meal in functional dyspepsia. Gut. 2008;57:1495–1503.  https://doi.org/10.1136/gut.2007.137125.CrossRefGoogle Scholar
  20. 20.
    Cassilly DW, Wang YR, Friedenberg FK, Nelson DB, Maurer AH, Parkman HP. Symptoms of gastroparesis: use of the gastroparesis cardinal symptom index in symptomatic patients referred for gastric emptying scintigraphy. Digestion. 2008;78:144–151.  https://doi.org/10.1159/000175836.CrossRefGoogle Scholar
  21. 21.
    Perano SJ, Rayner CK, Kritas S, et al. Gastric emptying is more rapid in adolescents with type 1 diabetes and impacts on postprandial glycemia. J Clin Endocrinol Metab. 2015;100:2248–2253.  https://doi.org/10.1210/jc.2015-1055.CrossRefGoogle Scholar
  22. 22.
    Bharucha AE, Camilleri M, Forstrom LA, Zinsmeister AR. Relationship between clinical features and gastric emptying disturbances in diabetes mellitus. Clin Endocrinol (Oxf). 2009;70:415–420.  https://doi.org/10.1111/j.1365-2265.2008.03351.x.CrossRefGoogle Scholar
  23. 23.
    Hayashi Y, Toyomasu Y, Saravanaperumal SA, et al. Hyperglycemia increases interstitial cells of Cajal via MAPK1 and MAPK3 signaling to ETV1 and KIT, leading to rapid gastric emptying. Gastroenterology. 2017;153:521–535.e20.  https://doi.org/10.1053/j.gastro.2017.04.020.CrossRefGoogle Scholar
  24. 24.
    Camilleri M. Functional dyspepsia and gastroparesis. Dig Dis. 2016;34:491–499.  https://doi.org/10.1159/000445226.CrossRefGoogle Scholar
  25. 25.
    Cooper CJ, Said S, Bizet J, Alkahateeb H, Sarosiek I, McCallum RW. Rapid or normal gastric emptying as new supportive criteria for diagnosing cyclic vomiting syndrome in adults. Med Sci Monit. 2014;20:1491–1495.  https://doi.org/10.12659/MSM.890547.CrossRefGoogle Scholar
  26. 26.
    Park K-J, Singer W, Sletten DM, Low PA, Bharucha AE. Gastric emptying in postural tachycardia syndrome: a preliminary report. Clin Auton Res. 2013;23:163–167.  https://doi.org/10.1007/s10286-013-0193-y.CrossRefGoogle Scholar
  27. 27.
    Bredenoord AJ, Chial HJ, Camilleri M, Mullan BP, Murray JA. Gastric accommodation and emptying in evaluation of patients with upper gastrointestinal symptoms. Clin Gastroenterol Hepatol. 2003;1:264–272. http://www.ncbi.nlm.nih.gov/pubmed/15017667.
  28. 28.
    Camilleri M, Breen M, Ryks M, Burton D. Proximal and overall gastric emptying of solids in patients with reduced gastric volume accommodation compared to matched controls. Dig Dis Sci. 2011;56:1729–1734.  https://doi.org/10.1007/s10620-011-1615-0.CrossRefGoogle Scholar
  29. 29.
    Scheffer RCH, Gooszen HG, Wassenaar EB, Samsom M. Relationship between partial gastric volumes and dyspeptic symptoms in fundoplication patients: a 3D ultrasonographic study. Am J Gastroenterol. 2004;99:1902–1909.  https://doi.org/10.1111/j.1572-0241.2004.40248.x.CrossRefGoogle Scholar
  30. 30.
    Lindeboom MYA, Vu MK, Ringers J, van Rijn PJJ, Neijenhuis P, Masclee AAM. Function of the proximal stomach after partial versus complete laparoscopic fundoplication. Am J Gastroenterol. 2003;98:284–290.  https://doi.org/10.1111/j.1572-0241.2003.07265.x.CrossRefGoogle Scholar
  31. 31.
    Donovan IA, Harding LK, Keighley MR, Griffin DW, Collis JL. Abnormalities of gastric emptying and pyloric reflux in uncomplicated hiatus hernia. Br J Surg. 1977;64:847–848. http://www.ncbi.nlm.nih.gov/pubmed/588981.
  32. 32.
    Camilleri M, Lembo A, Katzka DA. Opioids in gastroenterology: treating adverse effects and creating therapeutic benefits. Clin Gastroenterol Hepatol. 2017;15:1338–1349.  https://doi.org/10.1016/j.cgh.2017.05.014.CrossRefGoogle Scholar
  33. 33.
    Bagnol D, Mansour A, Akil H, Watson SJ. Cellular localization and distribution of the cloned mu and kappa opioid receptors in rat gastrointestinal tract. Neuroscience. 1997;81:579–591. http://www.ncbi.nlm.nih.gov/pubmed/9300443.
  34. 34.
    Moayyedi PM, Lacy BE, Andrews CN, Enns RA, Howden CW, Vakil N. Corrigendum: ACG and CAG clinical guideline: management of dyspepsia. Am J Gastroenterol. 2017;112:1484.  https://doi.org/10.1038/ajg.2017.238.CrossRefGoogle Scholar
  35. 35.
    Ardila-Hani A, Arabyan M, Waxman A, et al. Severity of dyspeptic symptoms correlates with delayed and early variables of gastric emptying. Dig Dis Sci. 2013;58:478–487.  https://doi.org/10.1007/s10620-012-2355-5.Google Scholar
  36. 36.
    Tack J, Janssen P, Masaoka T, Farré R, Van Oudenhove L. Efficacy of buspirone, a fundus-relaxing drug, in patients with functional dyspepsia. Clin Gastroenterol Hepatol. 2012;10:1239–1245.  https://doi.org/10.1016/j.cgh.2012.06.036.CrossRefGoogle Scholar
  37. 37.
    Van Oudenhove L, Kindt S, Vos R, Coulie B, Tack J. Influence of buspirone on gastric sensorimotor function in man. Aliment Pharmacol Ther. 2008;28:1326–1333.  https://doi.org/10.1111/j.1365-2036.2008.03849.x.CrossRefGoogle Scholar
  38. 38.
    Grover M, Camilleri M. Effects on gastrointestinal functions and symptoms of serotonergic psychoactive agents used in functional gastrointestinal diseases. J Gastroenterol. 2013;48:177–181.  https://doi.org/10.1007/s00535-012-0726-5.CrossRefGoogle Scholar
  39. 39.
    Ziessman HA, Bonta D V, Goetze S, Ravich WJ. Experience with a simplified, standardized 4-hour gastric-emptying protocol. J Nucl Med. 2007;48:568–572. http://www.ncbi.nlm.nih.gov/pubmed/17401093.

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Internal MedicineCleveland ClinicClevelandUSA
  2. 2.Quantitative Health SciencesCleveland ClinicClevelandUSA
  3. 3.Digestive Diseases and Surgery InstituteCleveland ClinicClevelandUSA

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