Articles
Delayed Gastric Emptying in Gastroesophageal Reflux Disease: Reassessment with New Methods and Symptomatic Correlations

https://doi.org/10.1097/00000441-200401000-00001Get rights and content

ABSTRACT

Background

Previous studies have shown that patients with gastroesophageal reflux disease (GERD) have slower rates of gastric emptying than control subjects, but the prevalence has differed because of variations in methodology. The recent establishment of international control values for scintigraphic gastric emptying assessment makes standardization of this technique possible. It would also be useful to determine whether specific gastrointestinal symptoms predicted delayed gastric emptying in GERD.

Methods

Forty-nine patients (mean age, 42.9 years; range, 24–65 years; 35 women, 14 men) who were diagnosed with GERD in the previous 12 months were given a standardized 280-kcal 99Tc-labeled low fat meal (egg beater). Percentage of intragastric residual content was recorded at baseline and at hourly intervals for 240 minutes by scintigraphy. Patients were also asked about the presence of dyspepsia (bloating, postprandial discomfort or belching, or early satiety), dysphagia, or regurgitation.

Results

Sixteen patients (33%) had intragastric residual contents greater than the 95th percentile (>40%) at 120 minutes, and 13 (26%) had abnormal results at 240 minutes (>6%). Dyspepsia was present in all patients. Regurgitation and dysphagia were common (present in approximately 80% and 40% of patients, respectively) and the prevalence of these symptoms did not differ between patients with normal versus delayed gastric emptying.

Conclusions

Using standardized techniques: 1) delayed gastric emptying is common in patients presenting with GERD at both 120 and 240 minutes after ingestion of a solid meal and 2) symptoms alone are not a useful predictor of this pathophysiology. Awareness of this subgroup of patients can be important in treatment strategies and long-term therapy.

Section snippets

Methods

Forty-nine patients with a mean age of 42.9 years (range, 24–65 years; 35 women, 14 men) were recruited for this study and fulfilled all eligibility criteria. All subjects had a history of GERD symptoms over the preceding 3 months. Subjects must have been diagnosed with GERD within 12 months via a) endoscopic criteria, defined as the presence of any mucosal disruptions in the distal esophagus (25 of 49 subjects); b) an abnormal ambulatory esophageal pH study with total time of distal esophageal

Results

Sixteen patients (33%) had retained intragastric contents greater than 95th percentile at 120 minutes after baseline. Thirteen patients (26%) had abnormal results at 240 minutes. The prevalence of diabetes mellitus in this study was 16% (n = 8), and diabetic patients accounted for 4 of the 16 patients (25%) with abnormally delayed emptying at 120 minutes and 5 of the 13 (38%) with abnormally delayed emptying at 240 minutes (Figure 1). Eleven patients had delayed emptying of solids at both 2 and 4 

Discussion

In this study, we have shown that delayed gastric emptying of solids is common in patients diagnosed with GERD. The prevalence of abnormally high residual intragastric contents at 4 hours after ingestion is approximately 25%. In addition, we have shown that common symptoms of delayed gastric emptying (ie, dyspepsia, regurgitation, and dysphagia) are common in patients with GERD and have no value in attempting to differentiate patients with abnormally slow gastric emptying from those that have

References (30)

  • K.M. Cunninghsm et al.

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

    Gut

    (1991)
  • B. Micali et al.

    Gastric emptying of solids in gastroesophageal reflux

    Gastroenterol Clin Biol.

    (1986)
  • R. Corinaldesi et al.

    Gastric acid secretion and emptying of solids and liquids in patients with severe reflux esophagitis [abstract]

    Gastroenterol

    (1989)
  • S. Cucchiara et al.

    Effects of omeprazole on mechanisms of gastroesophageal reflux in childhood

    Dig Dis Sci

    (1997)
  • G.J. Maddern et al.

    Solid and liquid gastric emptying in patients with gastrooesophageal reflux

    Br J Surg

    (1985)

    • Cited by (0)

    This work was supported in part by a grant from Reliant Pharmaceuticals, LLC.

    Portions of this work were presented in abstract form at the Meeting of the Southern Society for Clinical Investigation, New Orleans, Louisiana, February 22, 2003.

    View full text
    Copyright © 2004 Southern Society for Clinical Investigation. Published by Elsevier Inc. All rights reserved.