Pancreatitis and the Risk of Developing Gastric Neuromuscular Dysfunction.

Abstract

Most gastroparesis and functional dyspepsia cases (collectively, gastric neuromuscular dysfunction [GND]) remain idiopathic. It is believed that some idiopathic cases of GND may be triggered by an inflammatory insult to the gastrointestinal tract. We theorized that the profound foregut inflammation induced by pancreatitis could result in increased risk of GND. This was a case-control study of all patients undergoing gastric emptying scintigraphy between October 2017 and 2020 in an urban medical center with presumed GND. These were age-, sex-, and comparative health-matched to control patients with newly diagnosed microscopic colitis. Adjusted odds ratios (aORs) were calculated using conditional logistic regression. Among the 650 patients with GND, 359 had gastroparesis, and 9.2% had a history of acute pancreatitis (vs 3.1% of controls). Patients with GND demonstrated increased odds of having a history of acute pancreatitis (aOR 2.27, 95% confidence interval [CI] 1.33-4.03, P = 0.004) and recurrent pancreatitis (aOR 2.08, 95% CI 1.67-3.48, P = 0.002). Median time to GND diagnosis after first acute pancreatitis episode was 1,544 days (477.5, 3,832). Patients with a history of pancreatitis-associated GND had increased mortality vs controls (aOR 3.41, 95% CI 0.96-5.48). In addition, patients with pancreatitis-associated GND had more hospitalizations vs GND alone (13.8 vs 3.7, P < 0.0001) during the study period. This is the first study demonstrating an independent association between pancreatitis and the risk of GND, which occurred ∼4.2 years after the first episode of acute pancreatitis. Pancreatitis should therefore be regarded as a possible risk factor for developing GND with important consequences for healthcare utilization.