Tailored Prokinetic Therapy in Gastroparesis Using Gastric Emptying and Contractility.

Abstract

Background and aims: Physiologic biomarkers to predict prokinetic response in patients with gastroparesis-like symptoms are needed to better tailor management. This study aims to investigate phenotypes of antral high-amplitude contraction (HAC) counts relative to gastric emptying delay in patients with upper gastrointestinal (UGI) symptoms and examine response to prokinetics.

Methods: We retrospectively analyzed patients with UGI symptoms undergoing wireless motility capsule (WMC) testing. Data were collected on demographics, gastric emptying time (GET), Gastroparesis Cardinal Symptom Index (GCSI) scores, and prokinetic use. The number of HACs during a fasting period was counted. A single HAC was defined as a pressure amplitude > 65 mmHg within 20 min. Subjects were classified based on GET and HAC counts. The Wilcoxon signed-rank test compared GCSI scores at baseline and 6 months, in those with and without prokinetic use.

Results: In 135 patients, four distinct phenotypes were identified: non-delayed GET non-elevated HAC count (54.8%), non-delayed GET elevated HAC count (9.6%), delayed GET non-elevated HAC count (20.7%), and delayed GET elevated HAC count (14.8%). A total of 48.1% of all patients were on prokinetics. Those with delayed GET and elevated HAC counts showed significant improvement in GCSI scores only in subjects using prokinetics (2.95 vs. 1.98, diff -0.98, p = 0.03). In non-delayed GET, non-elevated HAC count, GCSI scores improved both with (2.61 vs. 1.68, diff -0.93, p < 0.01) and without (2.47 vs. 1.87, diff -0.61, p < 0.01) prokinetics.

Conclusion: We identified a specific phenotype of delayed GET elevated HAC count, representing patients with poor capsule exiting efficiency, which could be a biomarker for tailored prokinetic therapy.

Trial registration: NCT02022826.