Rapid Gastric Emptying: An Under-Recognized Clinical Entity?

Abstract

Introduction: Rapid gastric emptying (RGE) is defined as less than 30% retention of gastric contents at 1 hour of solid meal, gastric emptying scintigraphy (GES). Given the infrequent nature of this phenomenon, most studies regarding RGE have been relatively small. There is a paucity of data concerning the clinical profile of patients with rapid emptying, and even less regarding recognition of RGE as a distinct clinical entity. In this retrospective analysis, we attempted to characterize the clinical profile of RGE, and determine if RGE was recognized by the clinician. Methods: Patients over the age of 18 who underwent solid meal gastric-emptying scintigraphy (GES) at Cleveland Clinic from January 2011 to September 2012 and from May 2014 to December 2015 were included. GES was performed using the standardized protocol of oral ingestion of 1 mCi of Tc-99m sulfur colloid mixed with an egg meal followed by imaging over the abdomen obtained in the anterior and posterior projections at 0, 1, 2 and 4 hours. Records of patients with RGE were reviewed for demographic and clinical data. Results: 305/3641 (8.7%) of patients undergoing GES had RGE. Of these, 82.6% were noted to be symptomatic. Clinical characteristics and associated diseases are detailed in Table 1. Findings included an association with diabetes, autonomic dysfunction and functional gastrointestinal disorders. Additionally, RGE was found in patients who had previously undergone fundoplication or lung transplantation. Of note, 30.2% of patients with RGE were on opiates when GES was performed. RGE was acknowledged by the ordering physician in just 17 cases (5.6%). Therapies offered included the 5HT1a agoinst buspirone, neuromodulators, anti-emetics, or dietary modification.Table: Table. Patient characteristics and associated diseasesConclusion: While rapid gastric emptying was found in 8.7% of patients undergoing gastric emptying scan, it was rarely acknowledged by the clinician. RGE was found in patients with many disorders more commonly thought to be associated with gastroparesis, including opiate use. Further research regarding pathogenesis and treatment of rapid gastric emptying is warranted.