Prevalence of Esophageal Dysmotility in Patients with Idiopathic Refractory Gastroparesis

Abstract

Purpose: Asymptomatic esophageal dysmotility is common in diabetics, especially those with evidence of autonomic neuropathy such as gastroparesis. In idiopathic gastroparesis there is no identifiable primary abnormality to explain the delayed gastric emptying. The purpose of this study was to investigate the prevalence of esophageal dysmotility in patients with idiopathic refractory gastroparesis (RG), as compared to those with diabetic RG. Methods: Esophageal manometry (EM) studies were reviewed for consecutive patients with documented RG who had had EM performed as part of their pre-operative evaluation for placement of a gastric stimulator. 24 studies were reviewed; 3 EM studies were excluded from the analysis because of inadequate esophageal body recordings (2 studies with early termination secondary to coughing, 1 secondary to instrument miscalibration). To examine differences between normal and abnormal EM in idiopathic or diabetic RG, chi-square analysis was performed. Results: 81% of the patients were female. 38% of the patients had diabetic RG, while 62% had idiopathic RG. 48% of the EM studies demonstrated abnormalities. Only the patient diagnosed with nutcracker esophagus was symptomatic. 38% of patients with diabetic RG and 62% of patients with idiopathic RG had abnormal EM. There was no significant difference between the idiopathic and diabetic RG groups ((X2 (1, N = 21) = 0.03, p= NS). [Figure 1] Conclusions: As asymptomatic esophageal dysmotility is common in diabetics, it is not surprising that patients with diabetic gastroparesis also commonly have EM abnormalities. This study suggests a similar prevalence of esophageal dysmotility in patients with either idiopathic or diabetic RG. The mechanism of this finding is unclear, as is the etiology of idiopathic gastroparesis itself. A larger study is necessary to confirm these preliminary findings.Table