MORTALITY IN PATIENTS WITH GASTROPARESIS: A COMPARISON BETWEEN PATIENTS WITH AND WITHOUT DIABETES.

Abstract

Introduction Gastroparesis (GP) is an often serious disorder of gastric neuromuscular function, but the long-term survival of GP is unknown. We reviewed two studies of GP patients with and without diabetes either on long-term antiemetic therapy or implanted with gastric electric stimulation (GES) devices to examine mortality. Studies The first study was of 32 GP patients, treated with ondansetron (Zofran) alone, promethazine (Phenergan) alone, or both, followed for up to 10 years (1992-2002). Six patients had diabetes mellitus and 26 had idiopathic GP. Although long-term antiemetic therapy was effective in controlling nausea and vomiting, four diabetic and four idiopathic GP patients had died over 10 years, a mortality rate of 66% compared with 15% in the idiopathic group. In the second, 156 of 214 patients with symptoms of drug-refractory GP were treated with GES devices over a period of 13 years (1992-2005). Patients were subdivided into three groups: 107 idiopathic group, 32 diabetic group, and 17 postsurgical GP patients, all receiving GES devices. At the latest follow-up (median 4 years for 5,568 patient-months), most patients implanted (135 of 156) were alive with intact devices, had significantly reduced GI symptoms, reported improved health-related quality of life, and had evidence of improved gastric emptying. A total of 26 of 214 patients (12.1%) died. Among patients with permanent device implantation, 21 of 156 died (13.4%); this included 5 of 32(15.6%) DM and 16 of 124 (12.9%) non-DM. Patients consented but not implanted served as controls: of these, 5 of 25 (20.0%) died, 4 of 5 with DM (80%) and 1 of 5 (20%) without DM. Cause of death was primarily due to underlying disease and was not determined to be directly related to the GES device in any patient. Death among patients implanted was similar to those not implanted for nondiabetic patients (16/124 = 12.9% vs 1/5 = 20%) but lower for GES diabetic patients (5/32 = 15.6% vs 4/5 = 80%; p Conclusions Data from two recent studies demonstrate a definite improvement in the symptoms of GP in diabetic patients with long-term antiemetic therapy as well as permanent GES devices. There appears to be a significantly higher mortality in diabetic patients compared with GP patients with idiopathic and postsurgical disease. The high long-term mortality in patients with diabetes mellitus suggests that GP may be a marker of severe systemic disease for certain patients. In addition, the implantation of a GES device in DM GP appears to be associated with a lower mortality.