Jan Tack, Florencia Carbone; Alessandra Rotondo

Disclosures

Curr Opin Gastroenterol. 2015;31(6):499-505. 

In This Article

Symptom Pattern

A long-standing controversy is the differentiation between gastroparesis and functional dyspepsia.[3] The presence of worse gastric motor dysfunction, as in gastroparesis, is expected to generate more severe symptoms, including weight loss.[1] A single-center study analyzed symptom pattern, body weight, energy expenditure, and caloric intake in 29 idiopathic gastroparesis patients and 39 controls. BMI and resting energy expenditure were similar in both groups, but gastroparesis patients, as a group, had lower caloric intake and lower exercise-related energy expenditure. A subset of 12 gastroparesis patients who experienced weight gain had lower symptom burden and higher caloric intake compared with patients without weight gain.[4] Hence, weight loss is not a typical feature of gastroparesis patients.

Although the distinguishing feature of gastroparesis is the presence of delayed gastric emptying, the relationship between symptom pattern and degree of delay in emptying, and the efficacy of prokinetic drugs for symptom relief are areas of controversy.[3] In fact, the stability of delayed emptying over time is poor and the correlation between delayed emptying and symptoms in gastroparesis is at best modest. A systematic review confirmed that the symptomatic response to prokinetics is variable and poorly correlates with enhancement of gastric emptying.[5] Hence, it is assumed that other pathophysiological mechanisms, such as gastric hypersensitivity or impaired gastric accommodation, may also underlie symptoms in gastroparesis. A recent opinion article suggested a number of novel approaches to increase the clinical usefulness of a diagnosis of gastroparesis, including a higher threshold for diagnosing delayed gastric emptying and selection of patients based on a symptom pattern that includes nausea or vomiting, as these are more likely to be associated with delayed emptying.[3]

Similar issues also occur in pediatric gastroparesis. In a study of symptom pattern and psychosocial distress in 100 children referred for gastric emptying scintigraphy, gastroparesis was diagnosed in 25 based on a scintigraphic gastric retention value more than 10% at 4 h (abnormal for adults).[6,7] Symptoms evaluated in 83 patients with age more than 10 did not differ between those with normal and delayed emptying, and both groups had similar anxiety and somatization ratings. In the subgroup with delayed emptying, gastric retention was inversely correlated to severity of vomiting, nausea, difficulty to finish a normal sized meal, and somatization.[6] These findings confirm that symptoms and psychosocial distress cannot predict the presence of gastroparesis, and the majority of children with dyspeptic symptoms have normal gastric emptying. In the subset with delayed emptying, similar to adults,[3] nausea and vomiting best correlate with severity of delayed emptying.

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