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Gastric emptying measurements are mandatory in gastroparesis diagnostics, but the association between delayed emptying and symptoms is questionable. It is imperative to find biomarkers better correlated to symptom generation. Hence, we examined the association between symptom severity and gastrointestinal motility measured by wireless motility capsule. In this prospective single-centre study, patients with gastroparesis symptoms were simultaneously investigated with gastric emptying scintigraphy and wireless motility capsule, measuring regional transit times and contractility parameters. Symptom severity was assessed with the Patient Assessment of Upper Gastrointestinal Symptom Severity Index (PAGI-SYM), including the Gastroparesis Cardinal Symptom Index (GCSI). We included 107 patients (70% women). In the whole patient group, nausea correlated with the gastric ( = -0.31, = 0.007), small bowel ( = -0.41, < 0.001) and colonic ( = -0.33, = 0.012) motility indices. In patients with idiopathic etiology, nausea correlated with small bowel motility index ( = -0.81, < 0.001) and mean stomach pressure ( = -0.64, = 0.013). We also found negative correlations between total GCSI score and maximum pressure of the small bowel ( = -0.77, < 0.001) and colon ( = -0.74, = 0.002). In diabetes patients, total PAGI-SYM score correlated with colonic motility index ( = -0.34, = 0.012), and mean pressure of the colon correlated with upper abdominal pain ( = -0.37, = 0.007). We found no association between symptoms, gastric emptying nor any other transit times. In patients with gastroparesis symptoms, we found that symptom severity was associated with intestinal hypomotility. Based on these results, gastroparesis diagnostics should also include an evaluation of the small bowel and colon.

Background Diabetic constipation is traditionally attributed to slow colonic transit, despite limited evidence. More than half of patients find treatment unsatisfactory. To improve treatment, there is a need for better diagnostic understanding of the condition. Objective In this wireless motility capsule study, we aimed to investigate gastrointestinal transit and contractility in diabetes patients with and without constipation, and in healthy controls. Methods We prospectively included type 1 or type 2 diabetes patients with gastrointestinal symptoms. Based on the Gastrointestinal Symptom Rating Scale we distinguished into two groups: with constipation and without constipation. Non‐diabetic controls were asymptomatic. All were examined with wireless motility capsule, determining transit times and contractility parameters. Results 57 patients (42 women, 46 with type 1 diabetes) and 26 healthy controls (14 women) were included. We found no difference in transit times between diabetes patients with and without constipation. Compared to healthy controls (35:55, h:min), whole‐gut transit was slower in both diabetes patients with constipation (66:15, p = 0.03) and without constipation (71:16, p < 0.001). Small bowel motility index correlated rs = −0.32 (p = 0.01) with constipation symptoms. Conclusions Diabetes patients with constipation had similar transit times as those without constipation. Both groups had slower whole‐gut transit than healthy controls. Constipation was associated with reduced small bowel, but not colonic contractility. Our results imply that other mechanisms than slow colonic transit may be more important in the pathogenesis of diabetic constipation.