Delayed gastric emptying time among patients with refractory GERD using gastric scintigraphy: A pilot study

Abstract

Introduction: For patients with GERD refractory to acid-suppressive treatment, evaluation for the  presence of gastroparesis should be considered since delayed gastric emptying may possibly  aggravate symptoms of heartburn, regurgitation, and other symptoms that may overlap with  GERD. Studies concerning gastric emptying in GERD have long since provided conflicting  results.

Objective: To determine the relationship of gastric emptying time using gastric scintigraphy in  patients with refractory GERD and to determine whether delayed gastric emptying can predict  severity of gastrointestinal symptoms in GERD. 

Methods: A pilot study was done between October 2019 and November 2022 wherein 30 patients  were recruited with 15 patients classified as typical GERD and 15 patients as refractory GERD.  Patients were asked to complete a closed ended questionnaire which included Gastroparesis  Cardinal Symptom Index (GCSI), GERD impact score (GIS), and the Quality of Life and Reflux  and Dyspepsia (QOLRAD). All patients underwent gastric emptying scintigraphy at St. Luke’s  Medical Center Quezon City Department of Nuclear Medicine. Delayed gastric emptying was  defined as more than 60% of solid meal remaining at 2 hours or more than 10% remaining at 4  hours.

Results: The mean age of the patients was 41.1 ±11.86. years. 53.3% (n=16) of the patients were  female. Overall out of 30 patients, 2 patients (6.7%) had delayed gastric emptying, 3 (10%) had  rapid gastric emptying and normal results for the rest of the patients (83%). There was 1 patient  (6.7%) with delayed gastric emptying and 1 patient (6.7%) with rapid gastric emptying in the  refractory GERD group. While in the typical GERD group, 1 patient (6.7%) has delayed gastric  emptying and 2 patients (13.3%) have rapid gastric emptying. There was no statistically  significant difference in the gastric emptying time between typical and refractory  GERD(p=0.830). Symptom scores between refractory and typical GERD were statistically  significant based on the QOLRAD score (p=0.004). There was no significant difference in the  GCSI (p=0.075), QOLRAD (p=0.722) and GIS (p=0.455) scores among those with delayed,  rapid and normal gastric emptying.

Conclusion: Findings from this pilot study showed there was no significant difference in  gastric emptying time between typical and refractory GERD. However, the small sample size of  this study is not sufficient to conclude this relationship. Preliminary data gathered from this  study will help in modifying the research methodology if pursued on a larger scale. This study  shows that majority of patients with GERD do not have delayed gastric emptying. Instead of it  being a major cause of GERD, delayed gastric emptying is more likely to be a potential cofactor  aggravating this condition.