Correlation of Gastric Scintigraphy and Clinical Symptoms in the Diagnosis of Gastroparesis and its Impact on Quality of Life: A Pan India Real World Study

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.