P1000 - A Retrospective Cohort Study to Evaluate the Differences Between Cohorts of Patients with Rapid Gastric Emptying

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Varun Moktan, MD

Mayo Clinic
Jacksonville, FL, United States

Varun Moktan, MD¹, Marilia Montenegro, MD¹, Aman S. Bali, MD², Joseph Accurso, MD¹, David J. Cangemi, MD³, Brian E. Lacy, MD, PhD, FACG¹
¹Mayo Clinic, Jacksonville, FL; ²Mayo School of Graduate Medical Education, Jacksonville, FL; ³Mayo Clinic Health System, Jacksonville, FL

Introduction: Rapid gastric emptying (RGE) is defined as > 30% retention ( > 70% emptying) of gastric contents at 1-hour on gastric emptying scintigraphy (GES). However, the clinical significance of mild to moderate increases in gastric emptying (30-69%) at 1-hour is unclear. RGE is commonly associated with dumping syndrome, although other diseases such as diabetes, autonomic neuropathies, and functional gastrointestinal disorders have also been implicated. The aim of this study is to further characterize the extent of rapid gastric emptying based on symptoms, co-morbid conditions, medications, and indications for GES.

Methods: We identified a cohort of 258 adult patients ( >18 years old) who underwent a 4-hour GES at a tertiary medical center with increased gastric emptying at 1-hour (≥ 30%). Patients with a history of esophageal or thoracic surgery were excluded. Patients were divided into cohorts at 1-hour emptying times (30-39%, 40-49%, 50-59%, 60-69% and > 70%). Demographics, medications, TSH and HgbA1c, and indications for testing were recorded. Additionally, we assessed whether the results of the GES led to a change in management.

Results: The vast majority of the patients were in the 30-39% (n=131; 50.8%) or 40-49% (n=74; 28.7%) emptying cohorts. Only 10 (3.9%) patients met the previously define threshold of ≥ 70% emptying. The most common indications for gastric emptying studies were abdominal pain (25.6%), vomiting (33.7%), and nausea (39.1%), and there was no statistically significant difference among these indications across cohorts. Further, there was no difference in age, sex, BMI, comorbidities (including diabetes), medications, or subsequent management changes (medication change, dietary change, surgical intervention) across cohorts.

Discussion: In this retrospective cohort study of patients with increased gastric emptying at 1-hour on GES, only 4% of patients met the defined criteria for RGE ( > 70% emptying at 1-hour). Over 2/3 of patients had mild-moderately increased gastric emptying (30-49% emptying). Interestingly, there were no significant differences among all study variables across cohorts of varying degrees of increased gastric emptying. The clinical significance of mild-moderately increased gastric emptying warrants further investigation.

[30,40) (N=131)
[40,50) (N=74)
[50,60) (N=30)
[60,70) (N=13)
[70,100) (N=10)
Total (N=258)
P_value
Age

0.346
Mean (SD)
51.8 (15.6)
53.5 (17.5)
48.6 (15.0)
55.2 (16.9)
54.8 (20.7)
52.2 (16.3)

Median (Range)
53.0 (18.0, 83.0)
60.5 (18.0, 80.0)
47.0 (21.0, 74.0)
57.0 (24.0, 74.0)
64.0 (19.0, 77.0)
56.0 (18.0, 83.0)

Gender

0.078
female
97 (74.0%)
48 (64.9%)
16 (53.3%)
6 (46.2%)
6 (60.0%)
173 (67.1%)

male
34 (26.0%)
26 (35.1%)
14 (46.7%)
7 (53.8%)
4 (40.0%)
85 (32.9%)

Race

0.676
Asian
2 (1.5%)
1 (1.4%)
2 (6.7%)
0 (0.0%)
0 (0.0%)
5 (1.9%)

Black or African American
10 (7.6%)
7 (9.5%)
1 (3.3%)
0 (0.0%)
2 (20.0%)
20 (7.8%)

Choose not to disclose
1 (0.8%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
1 (0.4%)

Unknown
13 (9.9%)
4 (5.4%)
2 (6.7%)
0 (0.0%)
0 (0.0%)
19 (7.4%)

White
105 (80.2%)
62 (83.8%)
25 (83.3%)
13 (100.0%)
8 (80.0%)
213 (82.6%)

Ethnicity

0.201
Choose not to disclose
2 (1.5%)
0 (0.0%)
0 (0.0%)
1 (7.7%)
1 (10.0%)
4 (1.6%)

Hispanic or latino
6 (4.6%)
3 (4.1%)
2 (6.7%)
1 (7.7%)
1 (10.0%)
13 (5.0%)

Not hispanic or latino
103 (78.6%)
65 (87.8%)
25 (83.3%)
11 (84.6%)
6 (60.0%)
210 (81.4%)

Unknown
20 (15.3%)
6 (8.1%)
3 (10.0%)
0 (0.0%)
2 (20.0%)
31 (12.0%)

BMI

0.288
Mean (SD)
27.4 (9.0)
28.0 (7.3)
30.3 (10.8)
31.1 (8.0)
27.9 (5.2)
28.1 (8.6)

Median (Range)
26.5 (3.0, 98.7)
27.1 (15.1, 49.2)
29.3 (16.4, 71.6)
31.9 (19.8, 49.5)
28.0 (19.2, 35.6)
27.3 (3.0, 98.7)

Smoking status

0.155
N-Miss
1
0
0
0
0
1

non-smoker
114 (87.7%)
70 (94.6%)
24 (80.0%)
12 (92.3%)
10 (100.0%)
230 (89.5%)

smoker
16 (12.3%)
4 (5.4%)
6 (20.0%)
1 (7.7%)
0 (0.0%)
27 (10.5%)

Alcohol use

0.968
N-Miss
4
1
0
0
0
5

None
59 (46.5%)
34 (46.6%)
16 (53.3%)
8 (61.5%)
5 (50.0%)
122 (48.2%)

< 1 drink per day on average
59 (46.5%)
34 (46.6%)
11 (36.7%)
4 (30.8%)
4 (40.0%)
112 (44.3%)

1 or more drinks per day on average
9 (7.1%)
5 (6.8%)
3 (10.0%)
1 (7.7%)
1 (10.0%)
19 (7.5%)

TSH (last result within 6m of exam date)

0.094
Mean (SD)
1.7 (1.7)
2.6 (4.2)
1.9 (1.3)
1.1 (1.0)
1.0 (0.9)
1.9 (2.5)

Median (Range)
1.5 (0.0, 8.8)
1.9 (0.0, 29.0)
1.6 (0.0, 4.4)
0.9 (0.0, 2.5)
1.2 (0.0, 2.1)
1.6 (0.0, 29.0)

A1c (last result within 6m of exam date)

0.784
Mean (SD)
3.9 (2.9)
4.4 (3.2)
5.0 (3.3)
3.6 (3.2)
4.2 (3.3)
4.1 (3.1)

Median (Range)
5.2 (0.0, 8.4)
5.6 (0.0, 10.1)
5.5 (0.0, 11.8)
5.2 (0.0, 7.2)
6.0 (0.0, 7.2)
5.3 (0.0, 11.8)

Medications (choice=PPIs)

0.197
Checked
61 (46.6%)
46 (62.2%)
15 (50.0%)
5 (38.5%)
4 (40.0%)
131 (50.8%)

Unchecked
70 (53.4%)
28 (37.8%)
15 (50.0%)
8 (61.5%)
6 (60.0%)
127 (49.2%)

Medications (choice=SSRIs)

0.296
Checked
34 (26.0%)
10 (13.5%)
7 (23.3%)
4 (30.8%)
2 (20.0%)
57 (22.1%)

Unchecked
97 (74.0%)
64 (86.5%)
23 (76.7%)
9 (69.2%)
8 (80.0%)
201 (77.9%)

Medications (choice=SNRI)

0.429
Checked
8 (6.1%)
7 (9.5%)
1 (3.3%)
1 (7.7%)
2 (20.0%)
19 (7.4%)

Unchecked
123 (93.9%)
67 (90.5%)
29 (96.7%)
12 (92.3%)
8 (80.0%)
239 (92.6%)

Medications (choice=TCA)

0.735
Checked
6 (4.6%)
2 (2.7%)
1 (3.3%)
0 (0.0%)
1 (10.0%)
10 (3.9%)

Unchecked
125 (95.4%)
72 (97.3%)
29 (96.7%)
13 (100.0%)
9 (90.0%)
248 (96.1%)

Medications (choice=Mirtazapine)

0.656
Checked
2 (1.5%)
2 (2.7%)
1 (3.3%)
1 (7.7%)
0 (0.0%)
6 (2.3%)

Unchecked
129 (98.5%)
72 (97.3%)
29 (96.7%)
12 (92.3%)
10 (100.0%)
252 (97.7%)

Medications (choice=Buspirone)

0.909
Checked
2 (1.5%)
1 (1.4%)
1 (3.3%)
0 (0.0%)
0 (0.0%)
4 (1.6%)

Unchecked
129 (98.5%)
73 (98.6%)
29 (96.7%)
13 (100.0%)
10 (100.0%)
254 (98.4%)

Medications (choice=Pro-Kinetics)

0.777
Checked
11 (8.4%)
6 (8.1%)
1 (3.3%)
1 (7.7%)
0 (0.0%)
19 (7.4%)

Unchecked
120 (91.6%)
68 (91.9%)
29 (96.7%)
12 (92.3%)
10 (100.0%)
239 (92.6%)

Medications (choice=Anti-emetics)

0.274
Checked
44 (33.6%)
22 (29.7%)
5 (16.7%)
2 (15.4%)
2 (20.0%)
75 (29.1%)

Unchecked
87 (66.4%)
52 (70.3%)
25 (83.3%)
11 (84.6%)
8 (80.0%)
183 (70.9%)

Medications (choice=H2 blockers)

0.567
Checked
24 (18.3%)
8 (10.8%)
4 (13.3%)
3 (23.1%)
1 (10.0%)
40 (15.5%)

Unchecked
107 (81.7%)
66 (89.2%)
26 (86.7%)
10 (76.9%)
9 (90.0%)
218 (84.5%)

Medications (choice=Calcium channel blockers)

0.492
Checked
9 (6.9%)
9 (12.2%)
3 (10.0%)
2 (15.4%)
2 (20.0%)
25 (9.7%)

Unchecked
122 (93.1%)
65 (87.8%)
27 (90.0%)
11 (84.6%)
8 (80.0%)
233 (90.3%)

Medications (choice=Opiates)

0.817
Checked
13 (9.9%)
6 (8.1%)
3 (10.0%)
0 (0.0%)
1 (10.0%)
23 (8.9%)

Unchecked
118 (90.1%)
68 (91.9%)
27 (90.0%)
13 (100.0%)
9 (90.0%)
235 (91.1%)

Medications (choice=GLP-1 agonist)

0.025
Checked
0 (0.0%)
4 (5.4%)
0 (0.0%)
1 (7.7%)
1 (10.0%)
6 (2.3%)

Unchecked
131 (100.0%)
70 (94.6%)
30 (100.0%)
12 (92.3%)
9 (90.0%)
252 (97.7%)

Medications (choice=Cholinergic)

0.675
Checked
1 (0.8%)
2 (2.7%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
3 (1.2%)

Unchecked
130 (99.2%)
72 (97.3%)
30 (100.0%)
13 (100.0%)
10 (100.0%)
255 (98.8%)

Medications (choice=Anti-cholinergic)

0.722
Checked
15 (11.5%)
6 (8.1%)
3 (10.0%)
0 (0.0%)
1 (10.0%)
25 (9.7%)

Unchecked
116 (88.5%)
68 (91.9%)
27 (90.0%)
13 (100.0%)
9 (90.0%)
233 (90.3%)

Medications (choice=Others)

0.854
Checked
16 (12.2%)
7 (9.5%)
5 (16.7%)
1 (7.7%)
1 (10.0%)
30 (11.6%)

Unchecked
115 (87.8%)
67 (90.5%)
25 (83.3%)
12 (92.3%)
9 (90.0%)
228 (88.4%)

Comorbidities (choice=DM type 1)

0.914
Checked
6 (4.6%)
4 (5.4%)
1 (3.3%)
1 (7.7%)
0 (0.0%)
12 (4.7%)

Unchecked
125 (95.4%)
70 (94.6%)
29 (96.7%)
12 (92.3%)
10 (100.0%)
246 (95.3%)

Comorbidities (choice=DM type 2)

0.503
Checked
23 (17.6%)
15 (20.3%)
5 (16.7%)
2 (15.4%)
4 (40.0%)
49 (19.0%)

Unchecked
108 (82.4%)
59 (79.7%)
25 (83.3%)
11 (84.6%)
6 (60.0%)
209 (81.0%)

Comorbidities (choice=Hypothyroidism)

0.954
Checked
20 (15.3%)
9 (12.2%)
4 (13.3%)
2 (15.4%)
2 (20.0%)
37 (14.3%)

Unchecked
111 (84.7%)
65 (87.8%)
26 (86.7%)
11 (84.6%)
8 (80.0%)
221 (85.7%)

Comorbidities (choice=Celiac disease)

0.947
Checked
1 (0.8%)
1 (1.4%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
2 (0.8%)

Unchecked
130 (99.2%)
73 (98.6%)
30 (100.0%)
13 (100.0%)
10 (100.0%)
256 (99.2%)

Comorbidities (choice=Depression)

0.612
Checked
38 (29.0%)
15 (20.3%)
6 (20.0%)
4 (30.8%)
3 (30.0%)
66 (25.6%)

Unchecked
93 (71.0%)
59 (79.7%)
24 (80.0%)
9 (69.2%)
7 (70.0%)
192 (74.4%)

Comorbidities (choice=Anxiety)

0.942
Checked
35 (26.7%)
19 (25.7%)
10 (33.3%)
4 (30.8%)
3 (30.0%)
71 (27.5%)

Unchecked
96 (73.3%)
55 (74.3%)
20 (66.7%)
9 (69.2%)
7 (70.0%)
187 (72.5%)

Comorbidities (choice=Scleroderma)

NA
Unchecked
131 (100.0%)
74 (100.0%)
30 (100.0%)
13 (100.0%)
10 (100.0%)
258 (100.0%)

Comorbidities (choice=Sjogrens)

< 0.001
Checked
0 (0.0%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
1 (10.0%)
1 (0.4%)

Unchecked
131 (100.0%)
74 (100.0%)
30 (100.0%)
13 (100.0%)
9 (90.0%)
257 (99.6%)

Comorbidities (choice=POTS)

0.913
Checked
3 (2.3%)
1 (1.4%)
1 (3.3%)
0 (0.0%)
0 (0.0%)
5 (1.9%)

Unchecked
128 (97.7%)
73 (98.6%)
29 (96.7%)
13 (100.0%)
10 (100.0%)
253 (98.1%)

Comorbidities (choice=Ehlers Danlos)

0.947
Checked
1 (0.8%)
1 (1.4%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
2 (0.8%)

Unchecked
130 (99.2%)
73 (98.6%)
30 (100.0%)
13 (100.0%)
10 (100.0%)
256 (99.2%)

Comorbidities (choice=Autonomic dysfunction)

0.914
Checked
1 (0.8%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
1 (0.4%)

Unchecked
130 (99.2%)
74 (100.0%)
30 (100.0%)
13 (100.0%)
10 (100.0%)
257 (99.6%)

Comorbidities (choice=IBS)

0.625
Checked
17 (13.0%)
9 (12.2%)
3 (10.0%)
0 (0.0%)
2 (20.0%)
31 (12.0%)

Unchecked
114 (87.0%)
65 (87.8%)
27 (90.0%)
13 (100.0%)
8 (80.0%)
227 (88.0%)

Comorbidities (choice=IBD)

0.460
Checked
2 (1.5%)
3 (4.1%)
1 (3.3%)
0 (0.0%)
1 (10.0%)
7 (2.7%)

Unchecked
129 (98.5%)
71 (95.9%)
29 (96.7%)
13 (100.0%)
9 (90.0%)
251 (97.3%)

Comorbidities (choice=Cyclic vomiting syndrome)

0.947
Checked
1 (0.8%)
1 (1.4%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
2 (0.8%)

Unchecked
130 (99.2%)
73 (98.6%)
30 (100.0%)
13 (100.0%)
10 (100.0%)
256 (99.2%)

Comorbidities (choice=Others)

0.367
Checked
28 (21.4%)
12 (16.2%)
6 (20.0%)
4 (30.8%)
0 (0.0%)
50 (19.4%)

Unchecked
103 (78.6%)
62 (83.8%)
24 (80.0%)
9 (69.2%)
10 (100.0%)
208 (80.6%)

Indication (choice=Abdominal distension)

0.980
Checked
24 (18.3%)
16 (21.6%)
6 (20.0%)
3 (23.1%)
2 (20.0%)
51 (19.8%)

Unchecked
107 (81.7%)
58 (78.4%)
24 (80.0%)
10 (76.9%)
8 (80.0%)
207 (80.2%)

Indication (choice=Dyspepsia)

< 0.001
Checked
2 (1.5%)
2 (2.7%)
1 (3.3%)
3 (23.1%)
0 (0.0%)
8 (3.1%)

Unchecked
129 (98.5%)
72 (97.3%)
29 (96.7%)
10 (76.9%)
10 (100.0%)
250 (96.9%)

Indication (choice=Abdominal pain)

0.949
Checked
35 (26.7%)
17 (23.0%)
8 (26.7%)
4 (30.8%)
2 (20.0%)
66 (25.6%)

Unchecked
96 (73.3%)
57 (77.0%)
22 (73.3%)
9 (69.2%)
8 (80.0%)
192 (74.4%)

Indication (choice=Gastroparesis)

0.288
Checked
18 (13.7%)
17 (23.0%)
3 (10.0%)
1 (7.7%)
1 (10.0%)
40 (15.5%)

Unchecked
113 (86.3%)
57 (77.0%)
27 (90.0%)
12 (92.3%)
9 (90.0%)
218 (84.5%)

Indication (choice=GERD)

0.784
Checked
8 (6.1%)
4 (5.4%)
1 (3.3%)
0 (0.0%)
0 (0.0%)
13 (5.0%)

Unchecked
123 (93.9%)
70 (94.6%)
29 (96.7%)
13 (100.0%)
10 (100.0%)
245 (95.0%)

Indication (choice=Transplant evaluation)

0.935
Checked
7 (5.3%)
6 (8.1%)
2 (6.7%)
1 (7.7%)
1 (10.0%)
17 (6.6%)

Unchecked
124 (94.7%)
68 (91.9%)
28 (93.3%)
12 (92.3%)
9 (90.0%)
241 (93.4%)

Indication (choice=Weight loss)

0.851
Checked
3 (2.3%)
2 (2.7%)
0 (0.0%)
0 (0.0%)
0 (0.0%)
5 (1.9%)

Unchecked
128 (97.7%)
72 (97.3%)
30 (100.0%)
13 (100.0%)
10 (100.0%)
253 (98.1%)

Indication (choice=Vomiting)

0.119
Checked
52 (39.7%)
21 (28.4%)
9 (30.0%)
1 (7.7%)
4 (40.0%)
87 (33.7%)

Unchecked
79 (60.3%)
53 (71.6%)
21 (70.0%)
12 (92.3%)
6 (60.0%)
171 (66.3%)

Indication (choice=Nausea)

0.033
Checked
63 (48.1%)
20 (27.0%)
11 (36.7%)
3 (23.1%)
4 (40.0%)
101 (39.1%)

Unchecked
68 (51.9%)
54 (73.0%)
19 (63.3%)
10 (76.9%)
6 (60.0%)
157 (60.9%)

Indication (choice=Bloating)

0.466
Checked
22 (16.8%)
10 (13.5%)
7 (23.3%)
4 (30.8%)
1 (10.0%)
44 (17.1%)

Unchecked
109 (83.2%)
64 (86.5%)
23 (76.7%)
9 (69.2%)
9 (90.0%)
214 (82.9%)

Indication (choice=Others)

0.902
Checked
34 (26.0%)
15 (20.3%)
8 (26.7%)
3 (23.1%)
2 (20.0%)
62 (24.0%)

Unchecked
97 (74.0%)
59 (79.7%)
22 (73.3%)
10 (76.9%)
8 (80.0%)
196 (76.0%)

Table: Summary for Baseline and Clinical Characteristics Based on Different Gastric Emptying Rate Groups

Disclosures:
Varun Moktan indicated no relevant financial relationships.
Marilia Montenegro indicated no relevant financial relationships.
Aman Bali indicated no relevant financial relationships.
Joseph Accurso indicated no relevant financial relationships.
David Cangemi indicated no relevant financial relationships.
Brian Lacy indicated no relevant financial relationships.

Varun Moktan, MD¹, Marilia Montenegro, MD¹, Aman S. Bali, MD², Joseph Accurso, MD¹, David J. Cangemi, MD³, Brian E. Lacy, MD, PhD, FACG¹. P1000 - A Retrospective Cohort Study to Evaluate the Differences Between Cohorts of Patients with Rapid Gastric Emptying, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.