Prevalence and clinical correlates of antinuclear antibody in patients with gastroparesis

Authors: PARKMAN, HENRY - Temple University; VAN NATTA, MARK - Johns Hopkins University; MAKOL, ASHIMA - Mayo Clinic; GROVER, MADHUSUDAN - Mayo Clinic; MCCALLUM, RICHARD - Texas Tech University Health Science Center; MALIK, ZUBAIR - Temple University; KOCH, KENNETH - Wake Forest University; SAROSIEK, IRENE - Texas Tech University Health Science Center; KUO, BRADEN - Harvard Medical School; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); FARRUGIA, GIANNICO - 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; ABELL, THOMAS - University Of Louisville

Submitted to: Neurogastroenterology & Motility
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/31/2021
Publication Date: 10/1/2021
Citation: Parkman, H.P., Van Natta, M.L., Makol, A., Grover, M., Mccallum, R.W., Malik, Z., Koch, K.L., Sarosiek, I., Kuo, B., Shulman, R.J., Farrugia, G., Miriel, L., Tonascia, J., Hamilton, F., Pasricha, P.J., Abell, T.L. 2021. Prevalence and clinical correlates of antinuclear antibody in patients with gastroparesis. Neurogastroenterology & Motility. 34(5):e14270. https://doi.org/10.1111/nmo.14270.
DOI: https://doi.org/10.1111/nmo.14270

Interpretive Summary: Abnormally slow stomach emptying causes significant symptoms and distress in affected children and adults. When evaluating these individuals, it has been noted that a proportion have an abnormal antibody test (ANA) that may indicate possible autoimmune disease – where the immune system of the individual attacks tissues in the body. In this study, we found that adults with abnormally slow stomach emptying who had evidence of possible autoimmune disease (positive ANA) indeed had a higher risk of having an identifiable autoimmune disease and had different symptoms from those who did not have evidence of autoimmune disease. This study provides additional background on the causes of slow stomach emptying and evaluating different dietary approaches or other causes with the goal of improving overall health/well being for these individuals.

Technical Abstract: Autoimmunity may play a role in the pathogenesis of gastroparesis in a subset of patients. Antinuclear antibody (ANA) testing is often used to screen for autoimmune disorders. Determine prevalence of a positive ANA in patients with gastroparesis; 2) Describe characteristics of idiopathic gastroparesis patients with positive ANA. Patients were assessed with gastric emptying scintigraphy (GES), symptom assessment via Patient Assessment of Upper GI Symptoms [PAGI-SYM], and blood tests-ANA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP). Positive ANA was seen in 148 of 893 (17%) patients with gastroparesis, being similar in idiopathic (16% of 536 patients), T1DM (16% of 162), T2DM (18% of 147), and postfundoplication (19% of 48 patients) gastroparesis. Among 536 patients with idiopathic gastroparesis, ANA titer 1:40-1:80 was seen in 33 (6%) patients, 1:160-1:320 in 36 (7%) patients, and =1:640 in 17 (3%) patients. Increasing ANA titer was associated with female gender (p = 0.05), Hispanic ethnicity (p = 0.02), comorbid rheumatoid arthritis (p = 0.02), systemic sclerosis (p = 0.004), and elevated ESR (p = 0.007). ANA positivity was associated with lower total GCSI (p = 0.007) and lower nausea/vomiting subscale (p = 0.0005), but not related to gastric emptying. The prevalence of a positive ANA in patients with gastroparesis was high at ~17% and did not differ significantly based on etiology. In idiopathic patients, ANA positivity was associated with rheumatoid arthritis, systemic sclerosis, and elevated ESR. ANA-positive gastroparesis represents a subset who often have other autoimmune symptoms or disorders, but less severe nausea and vomiting.