Objective: 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. Patients and Methods: 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). Results: We included 107 patients (70% women). In the whole patient group, nausea correlated with the gastric (r_s = − 0.31, p = 0.007), small bowel (r_s = − 0.41, p < 0.001) and colonic (r_s = − 0.33, p = 0.012) motility indices. In patients with idiopathic etiology, nausea correlated with small bowel motility index (r_s = − 0.81, p < 0.001) and mean stomach pressure (r_s = − 0.64, p = 0.013). We also found negative correlations between total GCSI score and maximum pressure of the small bowel (r_s = − 0.77, p < 0.001) and colon (r_s = − 0.74, p = 0.002). In diabetes patients, total PAGI-SYM score correlated with colonic motility index (r_s = − 0.34, p = 0.012), and mean pressure of the colon correlated with upper abdominal pain (r_s = − 0.37, p = 0.007). We found no association between symptoms, gastric emptying nor any other transit times. Conclusion: 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.

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