Section on Gastroenterology, Wake Forest School of Medicine, Winston Salem, North Carolina, USA.
Section on Gastroenterology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Neurogastroenterol Motil. 2021 Mar;33(3):e13988. doi: 10.1111/nmo.13988. Epub 2020 Sep 18.
The cause of chronic nausea can be difficult to diagnose. Idiopathic rapid gastric emptying (iRGE) can cause nausea, but limited literature exists on clinical and pathophysiological features. In contrast, dumping syndrome or post-surgical rapid gastric emptying (psRGE) is well-known and may present with early phase vasomotor symptoms, diarrhea, and late phase reactive hypoglycemia. Our aim is to compare clinical and gastric motility characteristics in patients with iRGE and psRGE and unexplained chronic nausea.
A retrospective study was conducted on patients with unexplained chronic nausea and RGE (<30% retention of a standard isotope-labeled solid meal at 1-h). Gastric myoelectrical activity (GMA) was recorded during water load satiety tests (WLST) using validated electrogastrogram (EGG) recording methods.
Thirty iRGE and sixteen psRGE patients with unexplained chronic nausea were identified; average 1-hour meal retention was 18.6% and 16.2%, respectively. Nausea, bloating, early satiety, and bowel function were similar in the two groups; fewer iRGE patients had abdominal pain and none had vasomotor symptoms. Normal 3 cpm GMA was recorded in 44% of iRGE vs 29% of psRGE, tachygastria in 13% vs 43%, bradygastria in 25% vs 14%, and mixed in 19% vs 14% (p values >0.05). Abnormal WLST volume (<300 ml) was found in 69% of iRGE and 43% of psRGE (p = 0.36).
CONCLUSIONS & INFERENCES: (a) iRGE and psRGE patients may present with unexplained chronic nausea rather than classic vasomotor symptoms and diarrhea. (b) iRGE and psRGE patients had similar gastric dysrhythmias and accommodation dysfunction, which may contribute to RGE.
慢性恶心的病因难以诊断。特发性快速胃排空（iRGE）可引起恶心，但关于其临床和病理生理特征的文献有限。相比之下，倾倒综合征或术后快速胃排空（psRGE）是众所周知的，可能表现为早期血管运动症状、腹泻和晚期反应性低血糖。我们的目的是比较 iRGE 和 psRGE 以及不明原因慢性恶心患者的临床和胃动力特征。
对不明原因慢性恶心和 RGE（<1 小时时标准同位素标记固体餐保留<30%）患者进行回顾性研究。使用经过验证的胃电图（EGG）记录方法，在水负荷饱腹感测试（WLST）期间记录胃电活动（GMA）。
确定了 30 例 iRGE 和 16 例 psRGE 不明原因慢性恶心患者；平均 1 小时餐保留率分别为 18.6%和 16.2%。两组患者恶心、腹胀、早饱和肠道功能相似；iRGE 患者腹痛较少，无血管运动症状。44%的 iRGE 患者记录到正常 3 cpm GMA，而 psRGE 患者为 29%，13%的 iRGE 患者为心动过速，而 psRGE 患者为 43%，25%的 iRGE 患者为心动过缓，而 psRGE 患者为 14%，混合性为 19%和 14%（p 值>0.05）。异常 WLST 量（<300 ml）在 iRGE 患者中发现 69%，在 psRGE 患者中发现 43%（p = 0.36）。
（a）iRGE 和 psRGE 患者可能表现为不明原因的慢性恶心，而不是典型的血管运动症状和腹泻。（b）iRGE 和 psRGE 患者的胃动力节律紊乱和顺应性障碍相似，这可能是 RGE 的原因。
