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Association between delayed gastric emptying and upper gastrointestinal symptoms: a systematic review and meta-analysis
  1. Priya Vijayvargiya1,
  2. Sina Jameie-Oskooei1,
  3. Michael Camilleri1,
  4. Victor Chedid1,
  5. Patricia J Erwin2,
  6. Mohammad Hassan Murad3
  1. 1 Clinical Enteric Neuroscience Translational and Epidemiological Research (CENTER), Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
  2. 2 Division of Library Services, Mayo Clinic, Rochester, Minnesota, USA
  3. 3 Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota, USA
  1. Correspondence to Professor Michael Camilleri, Mayo Clinic, Rochester MN 55905, USA; camilleri.michael{at}


Background The relationship between delayed gastric emptying and upper GI symptoms (UGI Sx) is controversial.

Objective To assess association between gastric emptying and UGI Sx, independent of treatment.

Design We performed a systematic review and meta-analysis of the literature from 2007 to 2017, review of references and additional papers identified by content expert. We included studies evaluating the association between gastric emptying and nausea, vomiting, early satiety/postprandial fullness, abdominal pain and bloating. Covariate analyses included optimal gastric emptying test method, gastric emptying type (breath test or scintigraphy) and patient category. Meta-regression compared the differences based on type of gastric emptying tests.

Results Systematic review included 92 gastric emptying studies (26 breath test, 62 scintigraphy, 1 ultrasound and 3 wireless motility capsule); 25 of these studies provided quantitative data for meta-analysis (15 scintigraphy studies enrolling 4056 participants and 10 breath test studies enrolling 2231 participants). Meta-regression demonstrated a significant difference between optimal and suboptimal gastric emptying test methods when comparing delayed gastric emptying with nausea and vomiting. On evaluating studies using optimal gastric emptying test methodology, there were significant associations between gastric emptying and nausea (OR 1.6, 95% CI 1.4 to 1.8), vomiting (OR 2.0, 95% CI 1.6 to 2.7), abdominal pain (OR 1.5, 95% CI 1.0 to 2.2) and early satiety/fullness (OR 1.8, 95% CI 1.2 to 2.6) for patients with UGI Sx; gastric emptying and early satiety/fullness in patients with diabetes; gastric emptying and nausea in patients with gastroparesis.

Conclusions The systematic review and meta-analysis supports an association between optimally measured delayed gastric emptying and UGI Sx.

  • gastric emptying
  • upper gastrointestinal symptoms
  • gastric scintigraphy
  • breath test
  • association

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  • Contributors MC: staff supervisor and senior authorship. PV: data collation, analysis and coauthorship. SJ-O: data collation and coauthorship. VC: duplicate assessment of study bias and coauthorship. PJE: library search for literature review. MHM: methodology expert and coauthorship.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement MC accepts full responsibility for the conduct of the study and has had access to the data and control of the decision to publish.

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