The Relationship of Gastric Emptying and Symptoms in Patients with Functional Dyspepsia

Abstract

Purpose: Functional Dyspepsia (FD), a highly prevalent functional GI disorder, affects quality of life and significantly impacts the health care system. Symptoms of FD include early satiety, postprandial fullness, nausea and epigastric pain or discomfort. It has been proposed that patients with PDS (postprandial distress syndrome) are more likely to have delayed gastric emptying than those with EPS (epigastric pain syndrome). The aim of this study was to characterize gastric emptying abnormalities in FD patients based on subtype and evaluate the relationship between gastric emptying and predominant symptoms. Methods: A retrospective analysis of a prospectively gathered data base was analyzed. Men and women, aged 18 and over, categorized as meeting Rome III criteria for FD were eligible for inclusion. All patients had a normal upper endoscopy. Demographics (age, gender, BMI) were recorded; predominant FD symptoms were identified. Patients were categorized as having EPS, PDS or mixed EPS and PDS according to Rome III criteria. Gastric emptying scans (GES), when performed, were all four hour solid phase scans using a standardized protocol according to internationally recognized guidelines. GES were identified as normal if </= 10% of material remained at the 4-hour mark; rapid if <10% remained at the 2-hour mark; and slow if >10% remained at the 4-hour mark. For those with slow emptying, the extent of delay was further categorized as >20% and >30%. FD patients who did not undergo a gastric emptying scan were not included in this analysis. Results: 76 FD patients were analyzed. The mean age was 43.6 yrs (SD = 14.2); 83% were women. The mean BMI was 26.5 (SD = 6.7). 45% were identified as having EPS, while 46% had PDS and 9% had mixed EPS and PDS. The most common FD symptoms were upper abdominal pain (44.7%), fullness (25%), and early satiety (15.8%). Four-hour gastric emptying scans were normal in 76% of FD patients, rapid in 8% and delayed in 16%. Only two pts (2.6%) had a marked delay in gastric emptying (>30%). Slightly more PDS patients (7; 21%) had delayed gastric emptying than EPS Pts (4; 12%), although this was not statistically significant. Analysis of FD symptoms (pain, discomfort,fullness, nausea, bloating, regurgitation) found that early satiety was the only symptom to be associated with delayed 4 hr emptying (p = .04). Conclusion: The majority of FD patients have normal gastric emptying; very delayed gastric emptying is uncommon. PDS patients do not appear to be more likely to have delayed gastric emptying than EPS patients. Symptoms cannot reliably predict the presence or absence of gastric emptying abnormalities in FD patients. The utility of performing gastric emptying scans in FD patients warrants further scrutiny.