RESEARCH presented at the 2024 Annual Meeting of the American Foregut Society suggests that gastroparesis diagnoses based solely on gastric emptying studies may overlook broader gastrointestinal (GI) dysmotility, necessitating a shift in diagnostic approaches.
The retrospective study examined the prevalence of lower GI and multi-regional dysmotility in over 3,000 patients with gastroparesis who underwent wireless motility capsule testing at Cleveland Clinic between December 2010–January 2024.
Traditionally, gastroparesis diagnosis relies on symptomatic evaluation and gastric emptying tests using scintigraphy. For this study, researchers assessed motility using defined thresholds to classify delays in different GI regions: gastric emptying exceeding 5 hours, small bowel transit exceeding 6 hours, and colonic transit exceeding 59 hours. All participants had previously shown delayed gastric emptying on 4-hour scintigraphy.
Results showed that only 18.3% of those diagnosed with gastroparesis had isolated gastric delays on wireless motility capsule testing. In contrast, 81.7% had either normal transit times or delays in multiple regions of the GI tract. Among the cohort, 29.7% demonstrated normal motility across all regions, and 30.4% had isolated small-bowel or colonic delays. Meanwhile, 21.7% exhibited delays in the stomach and at least one other region.
The implications are significant for clinical practice. Gastroparesis, affecting up to 1.8% globally, has often prompted surgical interventions. However, this study suggests that only about 30% of diagnosed cases might benefit from surgery, emphasising the need for comprehensive motility assessments to tailor treatment effectively.
The authors highlighted that discontinuation of Medtronic’s Smart Pill, which previously enabled whole-GI transit assessments, has posed a challenge to comprehensive testing availability, but noted that an investigational wireless motility capsule, Atmo, under FDA review, could fill this gap by late 2024.
Additional research has corroborated the study’s findings, showing dysmotility in colonic and small-bowel regions in significant proportions of patients. These insights underline the need to address multi-regional GI dysfunction for better patient outcomes.
Reference
Loesch J et al. Small bowel & colon delays: a hidden factor in gastroparesis? Abstract 44. American Foregut Society 2024 Annual Meeting, 26–28 September, 2024.
