ABSTRACT
Background: Gastroparesis with its varied etiology is one of the major health issues in India. Poor correlation between delayed gastric emptying and its symptoms is well-known. This study was planned to evaluate the proportion of confirmed gastroparesis by scintigraphy among patients with suggestive clinical features, their underlying aetiologies and clinical profiling in a real-world setting in India. Settings and Design: Patients clinically diagnosed with gastroparesis, presenting varyingdegreesofsymptoms for at least 12-weeks, were enrolled in this multic-entric,cross-sectional, clinico-epidemiological study. Results: Overall, 196/201 enrolled patients underwent gastric scintigraphy; 88 (45%) were found to be scintigraphically positive and 108 (55%) patients were only clinically positive. Underlying etiologies of gastroparesis were idiopathic (51.2%), type-2 diabetes (44.8%), type-1 diabetes (2.5%) and psychological conditions (1.5%). Most patients presented symptoms like postprandial fullness (75.6%), bloating (50.7%), abdominal pain (45.3%), nausea (41.3%), abdominal discomfort (40.3%), early satiety (37.8%) and vomiting (17.9%) of moderate severity. Common dietary risk factors were fatty diet (66.7%), fiber-rich food (57.7%) and carbonated drinks (18.9%). Weight loss (6.5%), esophagitis (5.5%) and electrolyte disturbances (0.5%) were the associated complications. About 89.8% were on proton-pump inhibitors, followed by prokinetics (51.8%) and antiemetics (8.4%). The mean PAGI-QoL score was 3.6 ± 0.94, suggesting a moderate effect of gastroparesis on QoL. Conclusion: Poor correlation exists between gastric scintigraphy and gastrointestinal symptoms, thus reiterating the significance of the clinical diagnosis of gastroparesis, especially in diabetes. Only about half of the patients were prescribed prokinetics, emphasizing the need for appropriate pharmacotherapy using prokinetics for holistic management of gastroparesis.
ABSTRACT
BACKGROUND: Nausea and vomiting are predominant accompanying symptoms of migraine attacks. Although the underlying mechanism is not yet clear, gastric stasis is assumed to be the main factor. However, few studies have used direct methods to establish delayed gastric emptying of migraine patients. We compared interictal gastric motility between migraine patients and normal controls with the aid of gastric scintigraphy. METHODS: The study population comprised patients who had been diagnosed with episodic migraine, according to the International Classification of Headache Disorders, edition II. The entire study population was completely free of gastrointestinal symptoms during the headache-free period. Gastric scintigraphy was performed to determine the time to half emptying (T 1/2) and the percentage of radioactive material remaining in the stomach (%RMR) at 30, 60, 90, and 120 min. RESULTS: Twenty-six migraine patients and 12 normal controls were recruited. The mean T 1/2 did not differ between the two groups (101.8 vs 95.2 min; p=0.432). The %RMR values in the stomach at 30, 60, 90, and 120 min also did not differ significantly between the two groups [87.5% vs 88% (p=0.900), 70.8% vs 71.2% (p=0.950), 54.2% vs 53.3% (p=0.753), and 39.0% vs 37.3% (p=0.583), respectively]. CONCLUSIONS: There is no gastric stasis in patients with episodic migraine during headache-free periods. Our results suggest that the main mechanism underlying the nausea and vomiting in migraine patients is not a gastric stasis in interictal periods, but rather a central process, as a result of changes occurring in the brainstem during acute migraine attacks.