W2081 Neuropathic Pseudoobstruction a Frequent Cause of Nausea, Vomiting and Abdominal Pain

Background: Antroduodenal manometry (ADM) allows assessment of neural control and smooth muscle response throughout the stomach and small intestine.Patients with altered neural control of motility consistent with neuropathic pseudoobstruction present a therapeutic challenge.The Aim of this study was to determine 1) if the symptoms of gastroparesis, nausea (N), vomiting (V) or abdominal pain (AP), were associated with abnormal small intestinal motility and 2) the effect of altered small bowel function on gastric emptying and small bowel bacterial overgrowth (SBBO).Methods 174 ADM studies performed for the evaluation of moderate to severe upper GI symptoms, including N, V or AP, were analyzed for a presence of neuropathic pseudo-obstruction.ADM was performed during 3 hours of fasting and followed by sequential stimulation with erythromycin (ERY) and octreotide (OCT).Neuropathic pseudo-obstruction was defined as abnormal duodenal contractions during fasting (cluster, retrograde, or disorganized contractions with normal or increased amplitude).Gastric emptying (standardized egg beater meal) (47/50 patients) and lactulose breath testing (Quintron)(34/50 patients) were recorded.Results are expressed as mean + SEM.Results: Neuropathic pseudo-obstruction was seen on 28.7% of ADM studies.70% of patients were female with a mean age 45.9 + 2.2 and BMI 25.6 + 0.8.Six patients (12%) had diabetes mellitus.17 patients (34%) had previous abdominal surgery.Symptoms at the time of clinical evaluation were N/V (72%), AP (56%), and bloating/fullness (28%).Change in bowel habits was observed in 15 patients -diarrhea in 6 patients (12%) and constipation in 9 patients (18%).During fasting none of the 50 patients had duodenal MMC activity.ERY stimulated antral contractions in 40 patients (80%).OCT stimulated duodenal contractions in 45/50 patients (90%).Mean 2 and 4 hour gastric retention were 48.6% + 4.2% and 22.0% + 3.3%, respectively.Eleven patients (22%) had rapid gastric empting (gastric retention at 2 hours less or equal 15%).27 patients (57.4%) had delayed gastric emptying (gastric retention at 4 hours > 10%).A lactulose breath test showed small bowel bacterial overgrowth (SBBO) in 21/34 patients (61.7%).Conclusions: N, V with AP are frequently associated with an altered ADM consistent with neuropathic pseudoobstruction.Gastric emptying is variable in patients with these symptoms.SBBO is present in a large number of patients with disturbed intestinal motility.Thus, a disturbed intestinal motility pattern can be a major cause of severe N,V, and abdominal pain, even in patients with normal or rapid gastric emptying.