Postprandial symptoms in patients with symptoms of gastroparesis roles of gastric emptying and accommodation

Authors: PARKMAN, HENRY - Temple University Medical School; VAN NATTA, MARK - Johns Hopkins University; MAURER, ALAN - Temple University Medical School; KOCH, KENNETH - Wake Forest University; GROVER, MADHUSUDAN - Mayo Clinic; MALIK, ZUBAIR - Temple University Medical School; SAROSIEK, IRENE - Texas Tech University Health Science Center; ABELL, THOMAS - University Of Louisville; BULAT, ROBERT - Johns Hopkins University; KUO, BRADEN - Harvard Medical School; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); FARRUGIA, GIANRICO - Mayo Clinic; MIRIEL, LAURA - Johns Hopkins University; TONASCIA, JAMES - Johns Hopkins University; HAMILTON, FRANK - National Institute Of Diabetes And Digestive And Kidney Diseases; PASRICHA, PANKAJ - Johns Hopkins University; MCCALLUM, RICHARD - Texas Tech University Health Science Center

Submitted to: American Journal of Physiology - Gastrointestinal and Liver Physiology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 4/27/2022
Publication Date: 5/3/2022
Citation: Parkman, H.P., Van Natta, M.L., Maurer, A.H., Koch, K.L., Grover, M., Malik, Z., Sarosiek, I., Abell, T.L., Bulat, R., Kuo, B., Shulman, R.J., Farrugia, G., Miriel, L., Tonascia, J., Hamilton, F., Pasricha, P.J., McCallum, R.W. 2022. Postprandial symptoms in patients with symptoms of gastroparesis roles of gastric emptying and accommodation. American Journal of Physiology - Gastrointestinal and Liver Physiology. 323:G44-G59. https://doi.org/10.1152/ajpgi.00278.2021.
DOI: https://doi.org/10.1152/ajpgi.00278.2021

Interpretive Summary: Many adults and children have slow stomach emptying that is associated with nausea, vomiting, heartburn, and other symptoms after eating. The cause of these symptoms is not clear. In this study carried out in adults, we found evidence that symptoms are the result of a combination of factors. These included the inability of the stomach to expand normally after eating and the stomach being more sensitive to expansion than in healthy individuals. These results help point the way to goals of new treatments.

Technical Abstract: Patients often are evaluated for gastroparesis because of symptoms occurring with meals. Gastric emptying scintigraphy (GES) is used for gastroparesis diagnosis, although results are not well correlated with gastroparesis symptoms. The aim of this study is to assess relationships between gastroparesis symptoms, gastric emptying (GE), and gastric accommodation (GA). Patients with symptoms of gastroparesis completed the Patient Assessment of Upper GI Symptoms (PAGI-SYM) and recorded symptoms during GES and water load satiety test (WLST), an indirect assessment for GA. A total of 109 patients with gastroparesis symptoms were assessed. Symptom severity increased after GES meal for stomach fullness, belching, nausea, abdominal burning, and abdominal pain. There was no difference in symptoms after meal between patients with delayed (n = 66) and normal (n = 42) GE. Diabetic patients (n = 26) had greater gastric retention than idiopathic patients (n = 78), but idiopathic patients had greater postprandial nausea, stomach fullness, and abdominal pain. Water consumed during WLST averaged 421 +/- 245 mL. Idiopathic patients had greater nausea scores during WLST than diabetic patients. In comparison to those with normal water consumption (>=238 mL; n = 80), patients with impaired water ingestion (<238 mL; n = 26) had increased stomach fullness, early satiety, postprandial fullness, and loss of appetite on PAGI-SYM. Patients with delayed and normal GE had similar symptom profiles during GES and WLST. Idiopathic patients had less gastric retention but more symptoms after GES meal and after WLST compared with diabetic patients. Patients with impaired water consumption during WLST had increased symptoms by PAGI-SYM. These data suggest that impaired GA, rather than GE, may be important in explaining postprandial symptoms in patients with symptoms of gastroparesis.