Prevalence of impaired gastric emptying of solids in systemic sclerosis: Diagnostic and therapeutic implications

The aims of this study were to evaluate the gastric emptying of solids in p atients with progressive systemic sclerosis, correlate the esophageal motil ity abnormalities with their gastric emptying status, delineate the symptom s suggestive of abnormal gastric emptying, and assess the effect of metoclo pramide in patients with abnormally slow gastric emptying. Twenty patients underwent esophageal motility evaluation and gastric emptying studies with a radiolabeled solid meal. Gastric emptying was also measured in 13 healthy volunteers. Four patients in whom esophageal motility was normal also had an accompanying normal rate of gastric emptying. In 16 patients with abnorm al esophageal motility, mean gastric emptying was significantly delayed as compared with that in normal subjects (67.4% vs 49.8% retention of isotope at 2 hours, P<.05). Ten patients had absolute criteria for slow gastric emp tying (>+2 SD). However, only postprandial bloating and early satiety were symptoms that accurately predicted slow radionuclide emptying. In four of t hese patients in whom gastric emptying was slow, 10 mg intramuscular metocl opramide significantly (P <.05 vs baseline) accelerated the gastric emptyin g of the same test meal. We conclude that (1) gastric emptying of solids wa s delayed in approximately two thirds of patients with abnormal esophageal motility,whereas it was normal in patients with normal esophageal motor fun ction; (2) metoclopramide significantly accelerated this slow gastric empty ing; and (3) delayed gastric emptying contributes to the severity of the ga stroesophageal reflux frequently present in patients with progressive syste mic sclerosis, and promotility agents offer a valuable therapeutic approach .