Clinical Predictors of Rapid Gastric Emptying in Patients Presenting with Dyspeptic Symptoms

Abstract

Introduction: Rapid gastric emptying (RGE) is defined as less than 30% retention at 1 hour of solid meal ingestion in gastric emptying study (GES). The etiology of RGE is poorly understood, impaired fundic accommodation may contribute to rapid emptying. Additionally, the clinical significance of RGE is unknown. It remains unclear whether RGE is part of the spectrum of functional dyspepsia or represents a separate clinical entity. Our aim was to identify clinical variables associated with RGE in patients presenting with dyspeptic symptoms.1193_A Figure 1. Patient characteristics and medication list.Methods: We conducted a retrospective study of patients who underwent solid GES for evaluation of dyspeptic symptoms at our institution from January 2011 to September 2012. Patients with prior gastric surgery or delayed gastric emptying (>10% gastric retention at 4 hours) were excluded. Patients with RGE (<30% gastric retention at 1 hour) were compared to those with normal gastric emptying (NGE). Demographic data, relevant comorbidities, surgeries, medications, HbA1c and TSH were analyzed. Univariate and multivariable logistic regression analysis was performed using SAS (version 9.4, The SAS Institute, Cary, NC). Results: A total of 202 patients with RGE and 606 patients with NGE were reviewed. Mean gastric retention at 1 hour was 18% [12.0,24.0] for patients with RGE and 57% [30.0,73.0] for patients with NGE. The prevalence of patients with RGE vs NGE who met ROME IV criteria for functional dyspepsia was comparable (31.4% vs 29.2% p=0.57). There were no significant differences between groups in medications, other gastrointestinal conditions, neurological or psychiatric disorders and autonomic dysfunction. After multivariate logistic regression analysis patients with RGE were more likely to be older (OR 1.08 [1.01,1.1] p=0.018), male (OR 2.0 [1.4,2.9] p=<0.001), and have a higher BMI (OR 1.03 [1.00,1.05] p=0.018). Patients with diabetes mellitus had higher likelihood of RGE (OR 1.8 [1.2,2.7] p=0.05); however, there was no difference in HbA1c and TSH between the groups. RGE was 4.3 times more common in patients with prior fundoplication (OR 4.3 [2.4,7.7] p=<0.001). Conclusion: In patients presenting with dyspeptic symptoms; older males with higher BMI, diabetes mellitus and prior fundoplication had higher likelihood of rapid gastric emptying. History of surgical fundoplication was identified as the strongest clinical predictor of RGE.1193_B Figure 2. Patient comorbidities and relevant surgeries.