Predictors of gastroparesis in out-patients with secondary and idiopathic upper gastrointestinal symptoms

doi:10.1016/S1590-8658(03)00164-6

Digestive and Liver Disease

Volume 35, Issue 6, June 2003, Pages 389-396

https://doi.org/10.1016/S1590-8658(03)00164-6 Get rights and content

Abstract

Background. Delayed gastric emptying occurs frequently in patients with upper gastrointestinal symptoms associated with functional or organic diseases.

Aims. To evaluate whether: (i) the prevalence of delayed gastric emptying is influenced by the presence of organic disease; (ii) demographic or clinical factors predict modestly or markedly (gastroparesis) delayed emptying.

Patients. A total of 327 consecutive out-patients with upper gastrointestinal symptoms.

Methods. Routine diagnostic work-up and evaluation of demographic factors, gastrointestinal symptom evaluation and scintigraphic gastric emptying of solids were performed.

Results. Organic diseases were detected in 227/327 (65%) patients: 33% had delayed emptying and 20% gastroparesis. Female gender (OR: 2.1; 95% C.I.: 1.3–3.4), overweight (0.5; 0.3–0.9), relevant postprandial fullness (1.8; 1.1–3.2) and relevant epigastric bloating (1.8; 1.1–2.9), but not the presence of organic diseases, were associated with delayed emptying. Female gender (3.9; 1.3–11.9) and relevant postprandial fullness (4.1; 1.7–10.2) were associated with gastroparesis.

Conclusions. (i) There is a high prevalence of delayed gastric emptying and gastroparesis in out-patients with upper gastrointestinal symptoms, which is not influenced by the presence of organic disease; (ii) female gender, low body weight, relevant fullness and bloating are associated with delayed emptying; female gender and relevant postprandial fullness predict gastroparesis.

Introduction

Upper gastrointestinal symptoms represent one of the most common reasons for consultations with general practitioners and gastroenterologists [1]. In the majority of these patients, an investigative program that includes history, physical examination, laboratory assessments, oesophagogastroduodenoscopy and upper abdominal ultrasound can identify organic, metabolic or systemic diseases [2]. Moreover, in at least one third of cases, these investigations fail to establish the aetiology of symptoms; such patients are usually submitted to additional investigations, including measurement of gastric emptying, particularly when the symptomatic response to short-term treatment proves to be unsatisfactory.

In patients with unexplained gastric upper gastrointestinal symptoms, gastric emptying of solids is delayed in 30–50% of cases [2]. Delayed gastric emptying also occurs frequently in several organic diseases, including gastric ulcer [3], duodenal ulcer disease [4], gastro-oesophageal reflux [5], diabetes mellitus [6], atrophic gastritis [7], liver disease [8], and cholelithiasis [9]. In the majority of these patients, the magnitude of the delay in gastric emptying is relatively modest. Despite this, the terms ‘delayed emptying’ and ‘gastroparesis’ are usually utilised interchangeably. Moreover, it is intuitively likely that those patients in whom gastric retention of ingesta is markedly prolonged (gastroparesis) may have different characteristics from those in whom the delay in gastric emptying is modest. To our knowledge, this issue has not been evaluated.

The relationship between upper gastrointestinal symptoms and gastric emptying abnormalities is generally considered to be weak, so that in patients with either functional or organic disease, delayed gastric emptying cannot be identified on the basis of symptoms [6], [10]. However, recent studies, in highly selected patients with dyspepsia of unknown origin, have established that there is a close association between certain symptoms, such as postprandial fullness, and delayed gastric emptying when these symptoms are severe enough to influence usual activities [2], [11], [12]. There is also evidence in these patients that the rate of gastric emptying may also be dependent on demographic factors, including gender and body weight [2]. It is not known whether the presence or absence of organic diseases may influence associations between either demographic or clinical factors and the rate of gastric emptying. This issue is potentially relevant to the development of optimal strategies for the investigation and treatment of delayed gastric emptying in this group.

The aims of the present study were to determine, in unselected patients referred for the investigation of upper gastrointestinal symptoms, whether: (i) the prevalence of delayed gastric emptying is different in patients with and without organic diseases; (ii) patients with modest and marked (gastroparesis) delay in gastric emptying differ in clinical or demographic characteristics; (iii) demographic or clinical factors are predictors of delayed gastric emptying.

Section snippets

Patients

The study cohort was derived from out-patients who attended the Department of Internal Medicine of the University of Bologna between March 1996 and February 1998. A patient was included if he/she presented with, or was referred for, the assessment of upper gastrointestinal symptoms, i.e., if the patient suffered from epigastric pain, heartburn, acid regurgitation, postprandial epigastric fullness or bloating, nausea or vomiting. Patients who had predominant symptoms suggestive of irritable

Results

Among the 339 out-patients who were referred in the study period, 12 had previous major abdominal surgery and were excluded. All of the remaining 327 patients (150 males, 177 females; age 44.8±14.2 years; BMI 23.2±4.0 kg/m²) gave their informed consent to participate in the study. In 65% of the cases, organic disease was evident: oesophagitis in 17% of patients, duodenal ulcer or erosions in 16%, gastric ulcer in 5%, cholelithiasis or cholecystectomy in 6%, and other diseases (such as liver

Discussion

The major findings of this study are that: (i) a substantial proportion of patients referred to a tertiary centre for the evaluation of upper gastrointestinal symptoms has delayed emptying of solids, irrespective of the presence or absence of organic disease; (ii) in about 20% of patients with delayed emptying the magnitude of this delay is marked (‘gastroparesis’); (iii) patients with delayed emptying and gastroparesis differ in demographic and symptom characteristics from those with normal

Conflict of interest statement

V. Stanghellini is a recipient of a research grant from the Janssen Foundation and is currently acting as a consultant for Altana, Astra-Zeneca, Janssen-Cilag. M. Horowitz is currently acting as a consultant for Eli-Lilly.

Acknowledgements

Financial support: Vincenzo Stanghellini is a recipient of grant no. MURST Ex-40% 09 01 CD5 247. The study was partially sponsored also by an educational grant from Janssen Pharmaceutica. Part of this study was presented at Digestive Disease Week—AGA Meeting held in Orlando, May 1999, and it has been published in abstract form (Gastroenterology 1999;116:A336).

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Alimentary TractPredictors of gastroparesis in out-patients with secondary and idiopathic upper gastrointestinal symptoms

Abstract

Introduction

Section snippets

Patients

Results

Discussion

Conflict of interest statement

Acknowledgements

Gastroenterology

Am J Gastroenterol

Lancet

Dig Liver Dis

Gastroenterology

Am J Gastroenterol

Gastroenterology

Dig Liver Dis

Geographical differences in the prevalence of dyspepsia

Scand J Gastroenterol

Dysfunctions of the stomach with gastric ulceration

Dig Dis Sci

Gastric acid secretion and gastric emptying of liquids in 99 males with active duodenal ulcers

Dig Dis Sci

Relationships among autonomic nerve dysfunction, oesophageal motility and gastric emptying in gastro-oesophageal reflux disease

Gut

Gastric emptying in diabetes: an overview

Diabetes Med

Gastric emptying and dyspeptic symptoms in patients with non-autoimmune fundic atrophic gastritis

Dig Dis Sci

Delayed gastric emptying of both the liquid and the solid components of a meal in chronic liver disease

Am J Gastroenterol

Gastric emptying in patients with gallstone disease with or without dyspepsia: effect of cholecystectomy

Aust NZ J Surg

Lack of association between gastric emptying of solids and symptoms in nonulcer dyspepsia

J Clin Gastroenterol

Symptom pattern and gastric emptying rate assessed by the octanoic acid breath test in functional dyspepsia

Gastroenterology

Functional dyspepsia: a classification with guidelines for diagnosis and management

Gastroenterol Int

Functional gastroduodenal disorders

Gut

Validation of a questionnaire for functional dyspepsia in a multicenter setting

Gut

Reproducibility of a solid and of a liquid caloric meal for gastric emptying studies

Nucl Med Commun

Disturbed solid-phase gastric emptying in functional dyspepsia: a meta-analysis

Dig Dis Sci

Fasting and postprandial gastrointestinal motility in ulcer and non-ulcer dyspepsia

Gut

Alimentary Tract
Predictors of gastroparesis in out-patients with secondary and idiopathic upper gastrointestinal symptoms