A prospective study of gastric emptying and its relationship to the development of nausea, vomiting, and anorexia after autologous stem cell transplantation

BACKGROUND AND AIMS: Gastric motor dysfunction may be responsible, in some patients, for the nausea and emesis that occur following high-dose chemotherapy (HDT) and autologous stem cell transplantation (SCT). We sought to define the prevalence of gastric emptying abnormalities and their relationship to the development of nausea, vomiting, and anorexia in patients undergoing HDT and autologous SCT. METHODS: We prospectively studied patients with a variety of malignancies who received standard transplantation doses of chemotherapeutic agents and antiemetics. Gastric emptying was assessed prior to HDT and on Days 0 (day of stem cell infusion), +7, and +14 from SCT. Symptom assessment was obtained daily from initiation of HDT to 28 days after SCT. RESULTS: Twenty-four patients were studied. Prior to HDT, gastric emptying was rapid in two patients. Nausea, emesis, and anorexia occurred in all patients, peaked in severity at Day +7 after SCT and, with the exception of anorexia, had returned toward baseline levels by Day +28. As a group, gastric emptying was significantly slower on Days 0 and +7 and returned to baseline level by Day +14. Twenty-six percent and 44% of patients demonstrated delayed gastric emptying (T_1/2 >90 min) on Days 0 and +7, respectively, while 13% and 31% of patients had rapid gastric emptying (T_1/2 <30 min) on Days 0 and +7, respectively. Thirty-nine percent and 75% of patients had either rapid or delayed gastric emptying on Days 0 and +7, respectively. There was an association between delayed gastric emptying and moderate-severe anorexia on Day +7 and between delayed gastric emptying and at least mild vomiting on Day 0. Additionally, there was an association between rapid gastric emptying and at least mild vomiting on Day +7. Finally, an association was found between either rapid or delayed gastric emptying and at least mild nausea on Day +7. CONCLUSION: Both delayed and rapid gastric emptying occur commonly during the 2-wk period following HDT and autologous SCT and may be responsible, at least in part, for upper gastrointestinal symptoms that occur in these patients.