Relationships among intragastric meal distribution during gastric emptying scintigraphy, water consumption during water load satiety testing, and symptoms of gastroparesis

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

Submitted to: American Journal of Physiology - Gastrointestinal and Liver Physiology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/7/2023
Publication Date: 11/1/2023
Citation: Parkman, H.P., Wilson, L.A., Silver, P., Maurer, A.H., Sarosiek, I., Bulat, R.S., Kuo, B., Grover, M., Farrugia, G., Chumpitazi, B.P., Shulman, R.J., Malik, Z., Miriel, L.A., Tonascia, J., Hamilton, F., Abell, T.L., Pasricha, P.J., McCallum, R.W., Koch, K.L. 2023. Relationships among intragastric meal distribution during gastric emptying scintigraphy, water consumption during water load satiety testing, and symptoms of gastroparesis. American Journal of Physiology - Gastrointestinal and Liver Physiology. 325(5):G407-417. https://doi.org/10.1152/ajpgi.00065.2023.
DOI: https://doi.org/10.1152/ajpgi.00065.2023

Interpretive Summary: Slow stomach emptying (gastroparesis) often causes multiple severe symptoms including belly pain, vomiting, loss of appetite, and weight loss that affects children and adults and lasts for years. We investigated what tests actually relate to the symptoms described by people with slow stomach emptying. We found that testing how well the stomach stretches after a meal or drinking a large amount of water tells us most about the symptoms that slow stomach emptying can cause. This information will help us focus on treatments that impact the stomach’s sensitivity to stretching.

Technical Abstract: Gastric emptying scintigraphy (GES) measures total gastric retention after a solid meal and can assess intragastric meal distribution (IMD). Water load satiety test (WLST) measures gastric capacity. Both IMD immediately after meal ingestion [ratio of proximal gastric counts after meal ingestion to total gastric counts at time 0 (IMD^0)] and WLST (volume of water ingested over 5 min) are indirect measures of gastric accommodation. In this study, IMD^0 and WLST were compared with each other and to symptoms of gastroparesis to gauge their clinical utility for assessing patients with symptoms of gastroparesis. Patients with symptoms of gastroparesis underwent GES to obtain gastric retention and IMD^0, WLST, and filled out patient assessment of upper GI symptoms. A total of 234 patients with symptoms of gastroparesis were assessed (86 patients with diabetes, 130 idiopathic, 18 postfundoplication) and 175 (75%) delayed gastric emptying. Low IMD0 <0.568 suggesting initial rapid transit to the distal stomach was present in 8% and correlated with lower gastric retention, less heartburn, and lower volumes consumed during WLST. Low WLST volume (<238 mL) was present in 20% and associated with increased severity of early satiety, postprandial fullness, loss of appetite, and nausea. Low IMD^0 is associated with less gastric retention and less heartburn. Volume of water consumed during WLST, while associated with IMD^0, has associations with early satiety, postprandial fullness, loss of appetite, and nausea. Thus, IMD^0 and WLST appear to overlap somewhat in their assessment of gastric physiology in adults with symptoms of gastroparesis but relate to different dyspeptic symptoms.