Prevalence and Clinical Correlates of Antinuclear Antibody in Patients with Gastroparesis

Authors

Henry P Parkman
Mark L Van Natta
Ashima Makol
Madhusudan Grover
Richard W McCallum
Zubair Malik
Kenneth L Koch
Irene Sarosiek
Braden Kuo
Robert J Shulman
Gianrico Farrugia
Laura Miriel
James Tonascia
Frank Hamilton
Pankaj J Pasricha
Thomas L Abell
NIDDK Gastroparesis Clinical Research Consortium

Publication Date

5-1-2022

Journal

Neurogastroenterology & Motility

DOI

10.1111/nmo.14270

PMID

34595805

PMCID

PMC8971139

PubMedCentral® Posted Date

5-1-2023

PubMedCentral® Full Text Version

Author MSS

Published Open-Access

yes

Keywords

Antibodies, Antinuclear, Arthritis, Rheumatoid, Female, Gastric Emptying, Gastroparesis, Humans, Nausea, Prevalence, Scleroderma, Systemic, Vomiting, autoimmune, idiopathic gastroparesis, gastric emptying

Abstract

BACKGROUND: Autoimmunity may play a role in the pathogenesis of gastroparesis in a subset of patients. Antinuclear antibody (ANA) testing is often used to screen for autoimmune disorders.

AIMS: 1) Determine prevalence of a positive ANA in patients with gastroparesis; 2) Describe characteristics of idiopathic gastroparesis patients with positive ANA.

METHODS: Patients were assessed with gastric emptying scintigraphy (GES), symptom assessment via Patient Assessment of Upper GI Symptoms [PAGI-SYM], and blood tests-ANA, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP).

RESULTS: Positive ANA was seen in 148 of 893 (17%) patients with gastroparesis, being similar in idiopathic (16% of 536 patients), T1DM (16% of 162), T2DM (18% of 147), and postfundoplication (19% of 48 patients) gastroparesis. Among 536 patients with idiopathic gastroparesis, ANA titer 1:40-1:80 was seen in 33 (6%) patients, 1:160-1:320 in 36 (7%) patients, and ≥1:640 in 17 (3%) patients. Increasing ANA titer was associated with female gender (p = 0.05), Hispanic ethnicity (p = 0.02), comorbid rheumatoid arthritis (p = 0.02), systemic sclerosis (p = 0.004), and elevated ESR (p = 0.007). ANA positivity was associated with lower total GCSI (p = 0.007) and lower nausea/vomiting subscale (p = 0.0005), but not related to gastric emptying.

CONCLUSIONS: The prevalence of a positive ANA in patients with gastroparesis was high at ~17% and did not differ significantly based on etiology. In idiopathic patients, ANA positivity was associated with rheumatoid arthritis, systemic sclerosis, and elevated ESR. ANA-positive gastroparesis represents a subset who often have other autoimmune symptoms or disorders, but less severe nausea and vomiting.