Introduction Idiopathic gastroparesis is a chronic disorder of the stomach characterised by delayed gastric emptying in the absence of recognisable causative pathology such as mechanical obstruction or diabetes. Presenting symptoms include early satiety, vomiting and weight loss. Investigation usually includes gastric emptying studies, however significant overlap in gastric emptying times (GET) between normal and abnormal populations can make diagnosis difficult. Using a case series of patients managed at Gloucestershire Hospitals NHS Foundation Trust we explore the relationship between symptomatic presentation and GET, and attempt to correlate factors predicting successful response to treatment.
Methods Patients with clinical features of gastroparesis, and GET of over 100 min on nuclear medicine studies were identified from local radiology and clinic databases. Medical notes were scrutinised for information regarding presenting symptoms, response to pharmacological treatment, requirement for nasojejunal feeding or surgical jejunostomy and subsequent tertiary referral for consideration of gastric neurostimulation. Patients were nominally split into those with prolonged and significantly prolonged GET. Specific clinical features and subsequent response to treatment were compared. Characteristics common to both groups were identified and outcomes of atypical treatment strategies noted.
Results The cohort (n=21, 18 female, 3 male, ages 18–74) was categorised on the basis of GET (Measured on nuclear study. Prolonged: n=13, GET<130 min. Significantly prolonged: n=8, GET>130 min). Whereas prevalence of most presenting symptoms was similar between groups weight loss and constipation were seen only in the significantly prolonged group (50% in both instances). Significant clinical improvement with oral domperidone and metoclopramide was disappointingly unusual, however was slightly more common in the prolonged group (43% vs 25%). GET was not a useful predictor of treatment response. Of four patients requiring jejunal feeding and tertiary referral for neurostimulation, two had only marginal prolongation in GET. Of four patients started on the 5HT4 agonist prucalopride for concomitant constipation, three noticed incidental improvement in gastroparetic symptoms. One patient reported improvement following Chinese acupuncture.
Conclusion The case series illustrates inherent difficulties in diagnosing and managing gastroparesis. It notes certain clinical features, such as weight loss and constipation, which may relate to more significant prolongations in GET. In isolation GET appeared to be a poor marker of disease severity and was not useful in reliably predicting treatment response or requirement for subsequent tertiary referral. Observations of symptomatic improvement with prucalopride, a drug currently unlicensed for this indication, suggest further study into its wider therapeutic use should be afforded.
Competing interests B Hudson: None declared, F Fayyaz: None declared, R Makins Conflict with: This author has previously acted as an advisor for shire pharmaceuticals.