Rapid Gastric Emptying: Insights from a Large Cohort Study on a Controversial Disorder

Rapid gastric emptying (RGE) is conventionally defined as ≥ 70% emptying of a standardized solid meal at 1 h using gastric emptying scintigraphy (GES). However, this threshold is not universally adopted, and variability exists in how accelerated gastric emptying is defined in practice. We aimed to better characterize patients with conventionally defined RGE as well as those with accelerated emptying not meeting this threshold, and to evaluate what clinical differences exist across varying degrees of accelerated gastric emptying.

We identified a cohort of 258 adult patients (≥ 18 years old) with increased gastric emptying (≥ 30% emptied at 1 h) at a tertiary medical center. Patients with a history of esophageal, gastric or thoracic surgery were excluded. Patients were stratified into three cohorts based on 1-h gastric emptying percentages: 30-49%, 50-69%, and ≥ 70%. Manual chart review was performed to extract data on demographics, medications, laboratory values, GES indications, and management changes resulting from GES findings.

The majority of patients (n = 205, 79.4%) were in the 30-49% emptying cohort. Only 10 patients (3.9%) met the conventional threshold of ≥ 70% emptying at 1 h. The most common indications for GES were nausea (39.1%), vomiting (33.7%), and abdominal pain (25.6%), with no statistically significant differences in indications across the 3 cohorts. Furthermore, there were no differences in age, sex, BMI, comorbidities, medications, or management changes between the cohorts.

RGE that meets current consensus criteria is uncommon in clinical practice. Clinical characteristics and interventions were similar among cohorts with different degrees of accelerated emptying. The current cutoff of ≥ 70% emptying at 1 h may not represent a clinically distinct phenotype, emphasizing the need for better criteria to guide diagnosis and management.