1243 The Association Between Gastroparesis and Slow Transit Constipation as Seen by Wireless Motility Capsule (WMC)

Abstract

INTRODUCTION: Gastroparesis refers to delayed gastric emptying in the absence of a gastric outlet obstruction, as diagnosed by >10% gastric retention at 4 hours on Gastric Emptying Scintigraphy (GES). It presents with nausea/vomiting, upper abdominal fullness/discomfort, and early satiety. Several conditions can predispose patients to developing the disease, but ∼50% of affected patients are found to have idiopathic gastroparesis. The gastrointestinal tract is well connected through a series of neuronal reflexes that act to stimulate/inhibit specific segments based on stimuli detected at other “upstream or downstream” locations. The existence of a “cologastric brake” has been postulated in the past – where stimuli in the colon activate ascending tracts that may modulate upper gastrointestinal function. Based on this premise, the aim of our study was to determine the relationship between constipation and gastroparesis. METHODS: We conducted a retrospective study of patients who had undergone both GES as well as Wireless Motility Capsule (WMC) testing at our institution. Patients were divided into two groups based on the results of the GES: normal gastric emptying or gastroparesis. Constipation was assessed via WMC and anorectal manometry (when available). Demographic data, co-morbidities, selected labs, and medications were analyzed. RESULTS: A total of 224 patients were reviewed (101 with normal gastric emptying and 123 with gastroparesis). Mean colonic transit time was 2,321 min (normal <3,540 min) for patients with normal gastric emptying and 2,665 min for patients with gastroparesis (P = 0.361). There were no significant differences between the groups in demographics, co-morbidities, labs, or medications with the exception of prokinetics (P = 0.004) which were more common in the gastroparesis group. Univariate logistical regression found no association between slow-transit constipation and mild/moderate gastroparesis (OR 1.13/0.92, P = 0.82/0.81) but did find a correlation with severe gastroparesis (OR 2.45, P = 0.01). This relationship was strengthened with the exclusion of diabetes mellitus (OR 3.5, P = 0.008). Dyssynergic defecation did not appear to be associated with gastroparesis regardless of severity. CONCLUSION: Severe gastroparesis appears to be associated with an increased prevalence of slow-transit constipation – even more so after eliminating confounders (diabetes mellitus). Conversely, dyssynergic defecation does not appear to have any impact on gastric emptying.