Constipation in patients with symptoms of gastroparesis: Analysis of symptoms and gastrointestinal transit

Authors: PARKMAN, HENRY - Temple University; SHARKEY, EMILY - Johns Hopkins University; MCCALLUM, RICHARD - Texas Tech University; HASLER, WILLIAM - University Of Michigan; KOCH, KENNETH - Wake Forest University; SAROSIEK, IRENE - Texas Tech University; ABELL, THOMAS - University Of Louisville; KUO, BRADEN - Harvard Medical School; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); GROVER, MADHUSUDAN - Mayo Clinic; FARRUGIA, GIANRICO - Mayo Clinic; SCHEY, RON - Temple University; TONASCIA, JAMES - Johns Hopkins University; HAMILTON, FRANK - National Institute Of Diabetes And Digestive And Kidney Diseases; PASRICHA, PANKAJ - Johns Hopkins University

Submitted to: Clinical Gastroenterology and Hepatology
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 8/1/2020
Publication Date: 10/28/2020
Citation: Parkman, H.P., Sharkey, E., McCallum, R.W., Hasler, W.L., Koch, K.L., Sarosiek, I., Abell, T.L., Kuo, B., Shulman, R.J., Grover, M., Farrugia, G., Schey, R., Tonascia, J., Hamilton, F., Pasricha, P.J. 2020. Constipation in patients with symptoms of gastroparesis: Analysis of symptoms and gastrointestinal transit. Clinical Gastroenterology and Hepatology. https://doi.org/10.1016/j.cgh.2020.10.045.
DOI: https://doi.org/10.1016/j.cgh.2020.10.045

Interpretive Summary: This study discovered that individuals with very slow stomach emptying (gastroparesis) commonly also have constipation. There is a relationship between the severity of the slow stomach emptying and how severe the constipation is. This is important because it means that these individuals likely will need treatments that address both the stomach emptying problem and the constipation. These findings are important as pediatricians look for nutritional interventions that can alleviate both concerns.

Technical Abstract: Constipation can be an important symptom in some patients with gastroparesis. The aims were to: 1) Determine prevalence of constipation and delayed colonic transit in patients with symptoms of gastroparesis; 2) Correlate severity of constipation to severity of symptoms of gastroparesis; and 3) Relate severity of constipation to GI transit delays assessed by gastric emptying scintigraphy (GES) and wireless motility capsule (WMC). atients with symptoms of gastroparesis underwent gastric emptying scintigraphy (GES), wireless motility capsule (WMC) assessing gastric emptying, small bowel transit, and colonic transit, and questionnaires assessing symptoms using a modified Patient Assessment of Upper GI Symptoms [PAGI-SYM] and Rome III functional GI disorder questionnaire. Of 338 patients with symptoms of gastroparesis, 242 (71.5%) had delayed gastric emptying by scintigraphy; 298 (88.2%) also met criteria for functional dyspepsia. Severity of constipation was severe/very severe in 34% patients, moderate in 24%, and none/very mild/mild in 42%. Increasing severity of constipation was associated with increasing symptoms of gastroparesis and presence of irritable bowel syndrome (IBS). Severity of constipation was not associated with gastric retention on GES or WMC. Delayed colonic transit was present in 108 patients (32% of patients). Increasing severity of constipation was associated with increasing small bowel transit time, colonic transit time, and whole gut transit time. Severe/very severe constipation and delayed colon transit occurs in a third of patients with symptoms of gastroparesis. The severity of constipation is associated with severity of gastroparesis symptoms, presence of IBS, small bowel and colon transit delay, but not delay in gastric emptying.