Digestive Diseases and Sciences

, Volume 63, Issue 12, pp 3417–3424 | Cite as

A Positive Correlation Between Gastric and Esophageal Dysmotility Suggests Common Causality

  • Thomas A. ZikosEmail author
  • John O. Clarke
  • George Triadafilopoulos
  • Kirsten A. Regalia
  • Irene S. Sonu
  • Nielsen Q. Fernandez-Becker
  • Monica C. Nandwani
  • Linda A. Nguyen
Original Article



Gastric and esophageal dysmotility syndromes are some of the most common motility diagnoses, but little is known about their interrelationship.


The aim of our study was to determine if a correlation exists between gastric and esophageal dysmotility syndromes.


We reviewed the records of all patients who underwent both solid gastric emptying scintigraphy (GES) and high-resolution esophageal manometry (HRM) within a 2 year period, with both done between August 2012 and August 2017. All GESs were classified as either rapid, normal, or delayed. All HRMs were classified according to the Chicago Classification 3.0. Correlations were assessed using Fisher’s exact test and multiple logistic regression.


In total, 482 patients met inclusion criteria. Of patients with a normal, delayed, and rapid GES, 53.1, 64.5, and 77.3% had an abnormal HRM, respectively (p < 0.05 vs. normal GES). Likewise, patients with an abnormal HRM were more likely to have an abnormal GES (54.9 vs. 41.8%, p = 0.005). Multiple logistic regression showed abnormal GES [odds ratio (OR) 2.14], age (OR 1.013), scleroderma (OR 6.29), and dysphagia (OR 2.63) were independent predictors of an abnormal HRM. Likewise, an abnormal HRM (OR 2.11), diabetes (OR 1.85), heart or lung transplantation (OR 2.61), and autonomic dysfunction (OR 2.37) were independent predictors of an abnormal GES.


The correlation between an abnormal GES and HRM argues for common pathogenic mechanisms of these motility disorders, and possibly common future treatment options. Clinicians should have a high index of suspicion for another motility disorder if one is present.


Gastroparesis Gastric emptying Esophageal motility disorder Diabetes mellitus Lung transplantation Enteric nervous system 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.


  1. 1.
    Jung HK, Choung RS, Locke GR III, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225–1233.CrossRefGoogle Scholar
  2. 2.
    Boland K, Abdul-Hussein M, Tutuian R, Castell DO. Characteristics of consecutive esophageal motility diagnoses after a decade of change. J Clin Gastroenterol. 2016;50:301–306.CrossRefGoogle Scholar
  3. 3.
    Liu N, Abell T. Gastroparesis updates on pathogenesis and management. Gut Liver. 2017;11:579–589.CrossRefGoogle Scholar
  4. 4.
    Marie I, Gourcerol G, Leroi AM, Menard JF, Levesque H, Ducrotte P. Delayed gastric emptying determined using the 13C-octanoic acid breath test in patients with systemic sclerosis. Arthritis Rheum. 2012;64:2346–2355.CrossRefGoogle Scholar
  5. 5.
    Ebert EC. Esophageal disease in scleroderma. J Clin Gastroenterol. 2006;40:769–775.CrossRefGoogle Scholar
  6. 6.
    Gustafsson RJ, Littorin B, Berntorp K, et al. Esophageal dysmotility is more common than gastroparesis in diabetes mellitus and is associated with retinopathy. Rev Diabet Stud. 2011;8:268–275.CrossRefGoogle Scholar
  7. 7.
    Suttrup I, Warnecke T. Dysphagia in Parkinson’s disease. Dysphagia. 2016;31:24–32.CrossRefGoogle Scholar
  8. 8.
    Rubinow A, Burakoff R, Cohen AS, Harris LD. Esophageal manometry in systemic amyloidosis. A study of 30 patients. Am J Med. 1983;75:951–956.CrossRefGoogle Scholar
  9. 9.
    Tangaroonsanti A, Lee AS, Crowell MD, et al. Impaired esophageal motility and clearance post-lung transplant: risk for chronic allograft failure. Clin Transl Gastroenterol. 2017;8:e102.CrossRefGoogle Scholar
  10. 10.
    Raviv Y, D’Ovidio F, Pierre A, et al. Prevalence of gastroparesis before and after lung transplantation and its association with lung allograft outcomes. Clin Transplant. 2012;26:133–142.CrossRefGoogle Scholar
  11. 11.
    Faraj J, Melander O, Sundkvist G, et al. Oesophageal dysmotility, delayed gastric emptying and gastrointestinal symptoms in patients with diabetes mellitus. Diabet Med. 2007;24:1235–1239.CrossRefGoogle Scholar
  12. 12.
    Ohlsson B, Melander O, Thorsson O, Olsson R, Ekberg O, Sundkvist G. Oesophageal dysmotility, delayed gastric emptying and autonomic neuropathy correlate to disturbed glucose homeostasis. Diabetologia. 2006;49:2010–2014.CrossRefGoogle Scholar
  13. 13.
    Lowe HJ, Ferris TA, Hernandez PM, Weber SC. STRIDE—an integrated standards-based translational research informatics platform. AMIA Annu Symp Proc. 2009;2009:391–395.PubMedPubMedCentralGoogle Scholar
  14. 14.
    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. J Nucl Med Technol. 2008;36:44–54.CrossRefGoogle Scholar
  15. 15.
    Kahrilas PJ, Bredenoord AJ, Fox M, et al. The Chicago Classification of esophageal motility disorders, v3.0. Neurogastroenterol Motil. 2015;27:160–174.CrossRefGoogle Scholar
  16. 16.
    Sato H, Takahashi K, Nakajima N, et al. Full-layer mucosal histology in achalasia: Histological epithelial wave is characteristic in “pinstripe pattern”-positive achalasia. Neurogastroenterol Motil. 2018;. Scholar
  17. 17.
    Putra J, Muller KE, Hussain ZH, et al. Lymphocytic esophagitis in nonachalasia primary esophageal motility disorders: improved criteria, prevalence, strength of association, and natural history. Am J Surg Pathol. 2016;40:1679–1685.CrossRefGoogle Scholar
  18. 18.
    Grover M, Bernard CE, Pasricha PJ, et al. Clinical-histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium. Neurogastroenterol Motil. 2012;24:531–539, e249.CrossRefGoogle Scholar
  19. 19.
    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.CrossRefGoogle Scholar
  20. 20.
    Malik Z, Sankineni A, Parkman HP. Assessing pyloric sphincter pathophysiology using EndoFLIP in patients with gastroparesis. Neurogastroenterol Motil. 2015;27:524–531.CrossRefGoogle Scholar
  21. 21.
    Khashab MA, Ngamruengphong S, Carr-Locke D, et al. Gastric per-oral endoscopic myotomy for refractory gastroparesis: results from the first multicenter study on endoscopic pyloromyotomy (with video). Gastrointest Endosc. 2017;85:123–128.CrossRefGoogle Scholar
  22. 22.
    Arts J, Holvoet L, Caenepeel P, et al. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007;26:1251–1258.CrossRefGoogle Scholar
  23. 23.
    Friedenberg FK, Palit A, Parkman HP, Hanlon A, Nelson DB. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103:416–423.CrossRefGoogle Scholar
  24. 24.
    Pandolfino JE, Gawron AJ. Achalasia: a systematic review. JAMA. 2015;313:1841–1852.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Thomas A. Zikos
    • 1
    Email author
  • John O. Clarke
    • 1
  • George Triadafilopoulos
    • 1
  • Kirsten A. Regalia
    • 1
  • Irene S. Sonu
    • 1
  • Nielsen Q. Fernandez-Becker
    • 1
  • Monica C. Nandwani
    • 1
  • Linda A. Nguyen
    • 1
  1. 1.Stanford Multidimensional Program for Innovation and Research in the Esophagus (S-MPIRE), Division of Gastroenterology and HepatologyStanford University School of MedicineStanfordUSA

Personalised recommendations