Demographics and Clinical Features of and Management Strategies Employed in Patients Admitted with a Diagnosis of Gastroparesis to a Large Metropolitan Hospital: A Pilot Study

Abstract

Introduction: Gastroparesis refers to a syndrome of delayed gastric emptying in the absence of mechanical obstruction. Hospitalizations for individuals who carry a diagnosis of gastroparesis continue to rise across the US, and readmission rates appear to be especially high. However, the precise nature of the patient population is not known. Optimal management strategies to prevent recurrent hospitalizations are needed. Aims: To assess the clinical characteristics, diagnostic and treatment strategies employed in the management of patients hospitalized with a diagnosis of gastroparesis. Methods: A MethOD database search for patients admitted with a diagnosis of gastroparesis as a primary or secondary diagnosis at Houston Methodist Hospital from 2012 to 2015 was performed. For this pilot study, 100 patients were randomly selected from a total of 1292. Data on demographics, laboratory studies, upper endoscopy (EGD), gastric emptying, and treatment strategies (medications, placement of feeding tubes, use of TPN, botulinum toxin injection, gastric electrical stimulation), the etiology of gastroparesis, hospitalization duration, and readmission rate were documented. Results: The patient population was 62% Caucasian, 62% female, with an average age of 66 years. In 27% gastroparesis was the primary diagnosis, with 44% having readmissions. 35% had a delayed gastric emptying study, however 57% of these patients were using narcotics at the time of the study. 14% of patients had retained food on EGD. Medication use included metoclopramide (63%), erythromycin (10%), domperidone (5%), proton pump inhibitors (PPI)(93%), and antiemetics (ondansetron, promethazine) (92%). 1% had a gastric pacemaker placed, 1% had Botox injection to the pylorus, 14% had a feeding tube placed (PEG, PEJ, Dobhoff), and 9% required TPN. In 70%, diabetes was the assumed etiology. 33% carried a psychiatric diagnosis (bipolar disorder, depression, anxiety). Conclusion: Patients admitted to our institution with a diagnosis of gastroparesis were predominantly Caucasian women. Over half had been given a diagnosis of gastroparesis without evidence of a delayed gastric emptying study or retained food on EGD. Of patients that had a delayed gastric emptying study, over half were on narcotics at the time of the study. Most patients were treated with a PPI or anti-emetic, and only slightly over half were given a trial of a pro-kinetic agent. Rarely did these patients receive any other interventions for gastroparesis.