Association between gastric accommodation and proximal gastric emptying in patient with gastroesophageal reflux disease

Background: Gastroesophageal reflux disease (GERD) has not only the abnormal function of transient lower esophageal sphincter but also abnormal function of stomach, both of (gastric accommodation (GA) and proximal gastric emptying (proximal GE)). Conflicting results of GA assessment in GERD patients have been reported between impaired or enhanced GA. As well as, no conclusion of a method to assess GA based on proximal gastric emptying scintigraphy (GES). The objectives of this study were twofold: first, to determine association between GA and proximal GE in patients with GERD and second, to determine correlation between upper gastrointestinal symptoms and abnormal of GA, GE in GERD patients. Materials and methods: Retrospective reviews of 41 GERD patients underwent esophagogastroduoscopy (EGD), GA by SPECT and GE by GES at King Chulalongkorn Memorial Hospital, Thailand during 1 January 2017 to 31 July 2019. The results of SPECT study show GA (maximal postprandial gastric volume (PGV) minus fasting gastric volume (FGV)) and the ratio of maximal PGV/FGV. The results of GES study reveal percent retention of total, proximal and distal stomach at 0, 30, 60, 90, 120, 180 and 240 minutes. The intragastric distribution of the radiolabeled meal (IMD⁰) was also calculated. All GA and GE data was calculated by using Image J software. The results of GA and percent of total, proximal and distal GE were compared to normal Thai healthy volunteer data. Correlation between GA and proximal GE were analyzed.

Results: Fourty one GERD patients (26 females, age 49.0±13.4 years) completed the study. Enhanced GA by maximal PGV/FGV ratio (65.8%) and delayed proximal GE at 30 and 60 minutes (58.5% and 65.8%, respectively) were mainly observed in GERD patients. The results of either GA or maximal PGV/FGV by SPECT were no significant correlation with percentage of proximal GE during 0 to 240 minutes or IMD⁰ by GES. Early satiety was the only symptom that had statistically significant correlation with delayed proximal GE (Odds ratio = 6.22, P=0.039). Conclusion: Mainly abnormal function of stomach in GERD was enhanced GA and delayed proximal GE. However, either GA or maximal PGV/FGV ratio measurement by SPECT were not significantly associated with proximal GE or IMD⁰ measurement by GES. Only early satiety symptom was significantly associated with delayed proximal GE. Our study suggests the proximal stomach plays a major role in pathogenesis of GERD. The empirical treatment of prokinetic agent may be useful.