Proximal and distal intragastric meal distribution during gastric emptying scintigraphy: Relationships to symptoms of gastroparesis

Abstract

Background Total gastric retention (TGR) from gastric emptying scintigraphy (GES) is used for diagnosing gastroparesis (Gp), but correlates poorly with patients' symptoms. Regional intragastric meal distribution (RIMD) can also be assessed from GES. This study classified patients' meal distribution as proximal or distal to relate RIMD to symptoms of Gp. Methods GES studies in patients (n = 193) and control subjects (n = 21) were selected for RIMD analysis. Patients completed Patient Assessment of Upper Gastrointestinal Symptoms (PAGI‐SYM) for symptom severity before GES. TGR was analyzed using % TGR, and RIMD used a proximal/distal gastric count ratio (PDCR). Results were classified as proximal or distal RIMD at 0, 1, 2, and 4 h postprandially based on their PDCR being above or below the median value of the patients. Results Patients with delayed GE and immediate post‐meal ingestion distal distribution had more severe early satiety and regurgitation. Distal distribution at 1 h had more severe early satiety and loss of appetite compared to proximal distribution. Patients with delayed GE and proximal distribution at 4 h had more severe nausea, retching, and vomiting compared to 4 h distal distribution. Severely delayed 4 h proximal distribution had more nausea than severely delayed 4 h distal distribution. Conclusions Increased early distal IMD in patients with delayed GE was associated with regurgitation and early satiety whereas increased late proximal IMD was associated with nausea, retching, and vomiting. Differentiating proximal from distal meal distribution patterns helps to relate symptoms to gastric dysfunction and may be helpful for directing therapy.

Gastric sensorimotor function and its clinical measurement

“…28 The paper by Silver et al provides a further layer of interest, demonstrating that differences in intragastric meal distribution during scintigraphy are also relevant to symptom expression. 2 The findings are in line with associations between symptoms and distribution of a radioscintigraphy meal as reported by Piessevaux et al in 2003. 17 However, it is also noted that aberrant meal distribution remains a higher-order dysfunction, potentially modifying symptom expression, but requiring additional work to understand causality and therapeutic implications.…”

“…The paper by Silver et al provides a further layer of interest, demonstrating that differences in intragastric meal distribution during scintigraphy are also relevant to symptom expression 2 . The findings are in line with associations between symptoms and distribution of a radioscintigraphy meal as reported by Piessevaux et al in 2003 17 .…”

“…Using scintigraphy, distal intragastric distribution of the meal correlated with symptoms of early satiation and weight loss 17 . These findings are confirmed in the paper of Silver et al, who associated early distal redistribution, probably reflecting impaired accommodation, with early satiation and late proximal retention with nausea, retching and vomiting 2 …”

“…Existing disease classifications are becoming increasingly controversial in this regard, owing to their overlaps, and with most pharmacological and interventional trials still typically yielding mixed or disappointing outcomes. The current work by Silver et al 2 is therefore commendable, as studies of this type remind the field to look beyond existing labels toward deeper mechanistic profiling.…”

“…The coordinated behaviors of these regions are essential to generating the normal gastric reservoir, trituration, and transit functions, and deviations may contribute to symptoms. In the current issue of Neurogastroenterology & Motility , Silver et al present correlations between patterns of intragastric meal distribution and symptoms during scintigraphy 2 . This review provides an overview of gastric sensorimotor function, current and emerging methods for clinical evaluation, and future directions.…”