1248 Late Onset Rapid Gastric Emptying: A New Entity to Explain Post-Prandial Symptoms

Abstract

INTRODUCTION: Symptomatic patients with a suspected upper GI dysmotility disorder may have a normal 4 hour gastric emptying (GE) using the standardized radioisotope labeled egg beater meal methodology and do not meet criteria for the diagnosis of either delayed or rapid gastric emptying. We propose conservative thresholds to identify abnormal gastric emptying patterns among such symptomatic patients determined to have normal gastric emptying (NGE) in order to classify a subset as meeting criteria for a new entity, late-onset rapid gastric emptying (LRGE). METHODS: We recruited and conducted IRB approved standardized 4-h GE studies on 19 healthy normal subjects (Mean age 49, 68% females, 68% Hispanics) and in 425 patients (Mean age 51, 80% females, 69% Hispanics, and 33% with diabetes) who had symptoms suggesting an upper GI dysmotility disorder and referred for a standardized 4-h GES from 2009 to 2015. Patients had postprandial symptoms ranging from nausea, early satiety, fullness, epigastric pain, stool urgency, and bloating. Their GES was reported as normal based on no rapid gastric emptying at 1 h or delayed GE at 2 or 4 hrs. The 95% upper reference limits for the decrement percentages in gastric retention values from 1-2 h, 2-3 h and 3-4 h were determined using normal distribution in the 19 healthy normal subjects. These thresholds were applied to from the 425 NGE patients referred from 2009-2015. A 95% confidence interval (CI) of LRGE prevalence was determined. RESULTS: Approximately 5% of patients who had normal standardized 4-h GES results had an abnormal GE pattern based on the proposed criteria for late-onset rapid gastric emptying. Our data raises awareness to apply the gastric emptying decrement cut offs we have established to identify the diagnosis of LRGE in patients who otherwise would be interpreted as having normal GE and this will enable an explanation and management for their postprandial symptom profile. CONCLUSION: Approximately 5% of patients who had normal standardized 4-h GES results had an abnormal GE pattern based on the proposed criteria for late-onset rapid gastric emptying. Our data raises awareness to apply the gastric emptying decrement cut offs we have established to identify the diagnosis of LRGE in patients who otherwise would be interpreted as having normal GE and this will enable an explanation and management for their postprandial symptom profile.