ABSTRACTBackgroundAlthough different gastric shapes are encountered in gastric emptying scintigraphy (GES), it is not known whether gastric shape is related to gastric emptying (GE) or symptoms.AimTo investigate different stomach shapes observed during GES and examine their associations with GE, body weight, and gastrointestinal (GI) symptoms.MethodsThis was a retrospective review of GES studies performed at our institution. Patients with prior gastric surgery were excluded. A classification of gastric shapes included: crescentic, J‐shaped, reversed‐L, cylindrical, and bag‐like. Gastric shapes were correlated with GE, BMI, and GI symptoms using PAGI‐SYM.Results397 GES studies were reviewed (317 females, age 40.0 ± 20.3 years, BMI 27.8 ± 13.8 kg/m2). Gastric shapes were: 41.8% crescentic/comma‐shaped, 34.0% J‐shaped, 19.9% reversed L‐shape, 2.8% cylindrical, and 1.5% bag‐like. BMI was highest in crescentic/comma‐shaped stomachs (30.1 ± 12.4 kg/m2) and lowest in bag‐like stomachs (25.2 ± 9.9 kg/m2; p = 0.022). Delayed GE was most pronounced in bag‐like stomachs (34.4 ± 33.1% retention at 4 h) and lowest in reversed‐L shape (10.3 ± 15.6% retention at 4 h; p = 0.008). Regurgitation severity was greatest in bag‐like stomachs (2.2 ± 1.5) compared to milder symptoms in reversed‐L shape (1.3 ± 1.4; p = 0.029). Heartburn severity was increased in bag‐like stomachs (2.3 ± 1.6) while patients with cylindrical stomachs reported least heartburn severity (1.1 ± 1.3; p = 0.11).ConclusionsA classification system based on five gastric shapes observed during GES showed that crescent‐shaped stomach was the most common shape and correlated with higher BMIs. Delayed GE was most pronounced in bag‐like stomachs and lowest in reversed‐L stomachs. Regurgitation and heartburn severity were greatest in bag‐like stomachs with milder symptoms in reversed‐L stomachs. Thus, gastric shape during GES is associated with gastric emptying, BMI, and symptom severity.