Brian Surjanhata, MD1, Allen Lee, MD2, Ingrid Guerrero López3, Jack Semler, PhD4, Braden Kuo, MD, MSc5; 1Boston Medical Center, Boston, MA; 2University of Michigan Health System, Ann Arbor, MI; 3University of Vic, Barcelona, Catalonia, Spain; 4Medtronic, Buffalo, NY; 5Massachusetts General Hospital, Boston, MA
Introduction: Many upper gastrointestinal (UGI) symptoms occur postprandially. The postprandial response (PPR) is a physiological increase in contractility to enable aboral transport of luminal contents. Catheter based manometry can detect the PPR, however it is limited in availability. Therefore, the PPR is rarely clinically assessed. The wireless motility capsule (WMC) previously demonstrated the ability to detect the PPR in a more accessible fashion. We aim to evaluate the small bowel and colonic PPR using WMC and correlate to regional gut transit times and UGI symptoms. Methods: Subjects > 18 years old with > 2 UGI symptoms (nausea, vomiting, upper abdominal pain, early satiation, bloating, postprandial fullness) for > 12 weeks suggestive of gastroparesis that underwent WMC testing were analyzed. A standardized 250 kcal Ensure® meal was ingested after an 8 hour fast following WMC ingestion to initiate the PPR. Only normal and mild to moderate delays in GET < 8 hrs could be analyzed. Contraction frequency (Ct) was compared in three consecutive 20-minute post-prandial windows compared to a 20-minute pre-prandial baseline. Normal PPR was defined as a 10 to 100% increase in Ct from baseline in any post-prandial window. A weak response was defined as change < 10%. A hypercontractile response was defined as > 100% change. Gastric (GET) and colonic transit (CTT) by WMC were compared using unpaired t-tests. Baseline gastroparesis cardinal symptom index (GCSI) and subcategories abdominal pain, nausea, fullness, and bloating scores were compared using Mann-Whitney U test. Results: 37 subjects were analyzed. 14 had gastroparesis (GET: 5 to 7 hours). No significant differences in GET and CTT were found between the three groups (p = NS). Patients with hypercontractile response had significantly higher bloating scores compared to weak responders (p < 0.05). Patients with normal responses did not have significantly different bloating scores compared to weak and hypercontractile responders. No significant differences in median GCSI, abdominal pain, nausea, and fullness scores were observed. Discussion: In this cohort with UGI symptoms, patients with hypercontractile PPR had higher baseline bloating scores compared to weak responders, suggesting a possible contribution to the perception of bloating. Similar baseline UGI symptom scores were otherwise observed in these patients possibly because of normal or only mild to moderate gastric delay being analyzed.
Table 1. Comparison of Regional Transit Time and Symptom Scores Between Weak, Normal, and Hypercontractile Postprandial Responses
Disclosures: Brian Surjanhata indicated no relevant financial relationships. Allen Lee indicated no relevant financial relationships. Ingrid Guerrero López indicated no relevant financial relationships. Jack Semler: Medtronic – Consultant. Braden Kuo: Medtronic – Grant/Research Support.