Gastroparesis Research Articles

Early detection and intervention in diabetic gastroparesis: Role of body surface gastric mapping

Diabetic gastrointestinal neuropathy is a diabetes-related complication, associated with a complex interplay of hyperglycemic damage, autoimmune responses, oxidative stress, gastrointestinal hormones, and vascular insufficiency. Patients with diabetes should be monitored and therapeutic intervention introduced to prevent neuropathy due to diabetes prior to “the point of no return”. Determining gastric bioelectrical activity by body surface gastric mapping may be a promising option to monitor diabetic gastrointestinal neuropathy.

The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index-Daily Diary (ANMS GCSI-DD): Psychometric validation and meaningful change threshold in patients with idiopathic or diabetic gastroparesis.

The American Neurogastroenterology and Motility Society Gastroparesis Cardinal Symptom Index-Daily Diary (ANMS GCSI-DD) is a patient-reported outcome (PRO) instrument for gastroparesis. This study evaluated the psychometric properties of the ANMS GCSI-DD and determined a meaningful change threshold using the data from a phase 2b trial in adults with moderate-to-severe idiopathic or diabetic gastroparesis (DG). The psychometric properties of ANMS GCSI-DD were analyzed using other clinician- and patient-reported outcomes from 242 patients during the 12-week trial. Trial exit interviews were conducted in a cohort of 32 patients to capture their perspectives on meaningful change from the trial. ANMS GCSI-DD demonstrated good performance: unidimensionality scores exhibited good fit; internal consistency reliability was >0.70; test-retest reliability was above 0.90, and convergent validity showed strong correlations (0.70-0.90) with overall severity rating and moderate correlations (0.30-0.70) with other outcomes. ANMS GCSI-DD scores discriminated among groups with varying severity of gastroparesis symptoms in known-groups validity (p < 0.001) and were responsive to symptom improvement. Triangulation of the quantitative anchor-based estimates of 0.9-1.4 category points as a meaningful change in the ANMS GCSI-DD composite score, and the qualitative exit interview findings of 0.5-1.5 as meaningful change, supports a one-point change on a five-point scale (0-4) as the meaningful change threshold. The ANMS GCSI-DD is a reliable and valid PRO instrument to employ in clinical development for patients with moderate-to-severe idiopathic or DG, and a one-point score change in the ANMS GCSI-DD composite score is recommended as a meaningful change threshold of symptom change.

Gastric Per-Oral Endoscopy Myotomy (G-POEM): Tips, Tricks, and Pitfalls.

The number of hospitalizations for gastroparesis has risen over 300% in recent decades with increased physical, psychological, and healthcare burdens. Gastric per-oral endoscopic myotomy (G-POEM) is a promising therapy for patients with refractory gastroparesis. This article reviews important considerations for G-POEM. Predictive factors for clinical success after G-POEM include diabetic and idiopathic gastroparesis, shorter gastroparesis duration, symptoms predominant of nausea and emesis, and gastric emptying study showing gastric retention of > 20% at 4h. Mucosal closure is a critical step for G-POEM; both sutures and clips have high success rates, with clips having a trend to lower success rates but with significantly shorter procedure time and cheaper cost. G-POEMs have an overall 61% pooled success rate at one year with a yearly 13% symptom recurrence rate. A careful patient selection can yield higher clinical success rates. Further studies are needed on variant G-POEM techniques for more durable outcomes.

Oral health statuses of individuals diagnosed with gastroparesis: A Cross-Section study.

Gastroparesis (GP) is a debilitating gastric motility disorder associated with digestive dysfunction, reduced quality of life (QoL), and increased mortality rates. There is no known cure for GP and treatment options are limited. The oral cavity is responsible for initiating digestion, yet the impact of GP symptom frequency on oral health status and oral healthcare utilization is not well understood. A 21-item electronic survey was developed and disseminated to a private GP social media forum. Survey questions explored GP symptom frequency, oral health status, dental care utilization, and oral health education post GP diagnosis. Descriptive and inferential statistics analysed data. There were 434 study participants. An overwhelming 83% reported GP negatively influenced their oral health and oral function. Significance was observed between GP symptom frequency and oral health status (p = <0.0001). The majority (81%) reported receiving dental care post GP diagnosis, yet (63%) reported current untreated dental concerns. Interestingly, (74%) of participants reported that they have never been educated about oral health risks associated with GP by any healthcare professionals. GP negatively affects oral health. Study participants reported a need for extensive dental treatments and high levels of untreated dental concerns. Results strongly support that preventive oral healthcare and education must be provided for individuals with a GP diagnosis. As leading oral disease prevention specialists, dental hygienists must be aware of the effects of GP on the oral cavity to help provide person-centred evidence-based care, improve digestive processes, and increase QoL for GP sufferers.

Electroacupuncture Promotes Gastric Motility by Suppressing Pyroptosis via NLRP3/Caspase-1/GSDMD Signaling Pathway in Diabetic Gastroparesis Rats.

To investigate the mechanism of electroacupuncture (EA) in treating diabetic gastroparesis (DGP) by inhibiting the activation of Nod-like receptor family pyrin domain-containing protein 3 (NLRP3) inflammasome and pyroptosis mediated via NLRP3/cysteinyl aspartate specific proteinase-1 (caspase-1)/gasdermin D (GSDMD) signaling pathway. Forty Sprague-Dawley rats were randomly divided into 4 groups including the control, DGP model, EA, and MCC950 groups. The DGP model was established by a one-time high-dose intraperitoneal injection of 2% streptozotocin and a high-glucose and high-fat diet for 8 weeks. EA intervention was conducted at Zusanli (ST 36), Liangmen (ST 21) and Sanyinjiao (SP 6) with sparse-dense wave for 15 min, and was administered for 3 courses of 5 days. After intervention, the blood glucose, urine glucose, gastric emptying, and intestinal propulsive rate were observed. Besides, HE staining was used to observe histopathological changes in gastric antrum tissues, and TUNEL staining was utilized to detect DNA damage. Protein expression levels of NLRP3, apoptosis-associated speck-like protein containing CARD (ASC), pro-caspase-1, caspase-1 and GSDMD were measured by Western blot. Immunofluorescence staining was employed to assess the activity of GSDMD-N. Lactate dehydrogenase (LDH) levels were detected by using a biochemical kit. DGP rats showed persistent hyperglycemia and a significant decrease in gastrointestinal motility (P<0.05 or P<0.01), accompanied by pathological damage in their gastric antrum tissues. Cellular DNA was obviously damaged, and the expressions of NLRP3, ASC, pro-caspase-1, caspase-1 and GSDMD proteins were significantly elevated, along with enhanced fluorescence signals of GSDMD-N and increased LDH release (P<0.01). EA mitigated hyperglycemia, improved gastrointestinal motility in DGP rats and alleviated their pathological injury (P<0.05). Furthermore, EA reduced cellular DNA damage, lowered the protein levels of NLRP3, ASC, pro-caspase-1, caspase-1 and GSDMD, suppressed GSDMD-N activity, and decreased LDH release (P<0.05 or P<0.01), demonstrating effects comparable to MCC950. EA promotes gastrointestinal motility and repairs the pathological damage in DGP rats, and its mechanism may be related to the inhibition of NLRP3 inflammasome and pyroptosis mediated by NLRP3/caspase-1/GSDMD pathway.

Prevalence and Severity of Diabetic Gastroparesis Symptoms in Relation to Diabetics in Saudi Arabia.

Gastroparesis is a chronic illness characterized by delayed emptying of the stomach without any mechanical obstruction and therefore presents with conditions such as bloating, early satiety, and abdominal pain, among others. In the Kingdom of Saudi Arabia population, it is a major risk factor because, through review, one can find very limited data on the prevalence and severity of the atrophic gastritis condition among diabetes populations in the region. The objectives of this study were to determine the magnitude and severity of symptoms of gastroparesis in type 1 and type 2 diabetic patients in Saudi Arabia, for information-based decision-making in health practices and policy. The design of the study, in the present research, is descriptive, cross-sectional, and non-intervening. Information is directly collected for this study from the 119 diabetic patients, both type 1 and type 2, directly by having interviews and telephone surveys during 2023-2024. Patients belong to the agegroup of 18-69 years; patientparticipation in the study is voluntary. The Gastroparesis Cardinal Symptom Index is used for scoring the prevalence followed by the symptoms. Descriptive and inferential statistics with the chi-square test and logistic regression models were used to analyze data. In this study, 68.4% were type 2 and 63.4% were type 1 diabetic patients and more than half of those with type 2 diabetes were in the age rangeof 50 to 59 years, while the ages of type 1 diabetic patients were evenly distributed. Key findings from this study are: There was a rate of 22.0% for the occurrence of moderate nausea in type 1 and 29.1% in type 2. Vomiting was infrequent in Type 2 (49.4%) compared to Type 1 (31%). Symptom severity: A significant statistical difference was judged by the feeling of stomach fullness (p = 0.038), with more occurrences among the type 2 DM patients. On univariate analysis, symptoms were more severe in younger patients (< 60 years). There were clear socio-economic disparities; non-Saudi nationals and those of a lower educational and income status reported much more severe symptomatology. This sign- and symptom-based substantiated research was done in Saudi Arabia to identify whether gastroparesis prevalence and severity differ in type 1 and type 2 diabetic patients. More patients suffering were young and had type 2 diabetes and low socio-economic status. Such findings would surely accentuate the need and call for indispensable, targeted interventions from more longitudinal studies, for a better approach and understanding of diabetic gastroparesis.

8189 Demographics and Healthcare Utilization of Diabetic Versus Non-Diabetic Gastroparesis hospitalization in the United States Using the National Inpatient Sample database

Abstract Disclosure: S. Khan: None. L. Zia: None. M. Khan: None. M. Amin: None. M. Khan: None. F. Sattar: None. Background: Gastroparesis is commonly associated with neuropathy secondary to Diabetes and Non-Diabetic causes such as Idiopathic, Post-Viral and Surgical with a wide spectrum of clinical manifestations impairing quality of life, worsening morbidity, and mortality. The purpose of this study is to assess Demographic disparities and utilization of healthcare services between Diabetic (DG) Versus Non-Diabetic Gastroparesis (NDG) admissions. Methods: Data were extracted from the National Inpatient Sample Database for the year 2020. It comprises discharge data obtained from a 20% stratified sample of community hospitals across the country. We conducted a retrospective cohort study focusing on admissions of patients aged 18 years and above with diagnosis of DG and NDG were identified using ICD-10 codes. Multivariate regression analysis was used to estimate the Mean difference of the Average length of hospital stay (LOS), and total hospital charges (THC). Multivariate logistic and linear regression was used accordingly to adjust for confounders. Analysis was performed using STATA 18. Results: Our study identified 10330 patients hospitalized due to gastroparesis, among them 1446 (14%) had DG. Hospitalizations with DG in comparison with NDG had lower number of women (65% Vs 80.7%, P≤0.05), a higher proportion of black adults (36.5% Vs 17%), a lower proportion of white adults (46.4% Vs 70%), and a higher Charlson Comorbidity Index. In DG, 104(7.19%) patients had EGD and non-diabetic gastroparesis, 977 (11%) had EGD during admission. The mean LOS in hospital was 4.72 days and mean total hospital charges were 51327 USD. Comparing both cohorts, there was statistically significant decrease in the mean LOS in DG, Adjusted Mean difference of 1.27 days (P = 0.006). In addition, there was significant decrease in the total cost of hospitalization with an adjusted Mean difference of 13832 (P=0.001). Thirty patients with NDG died during hospital course and none with Diabetic gastroparesis. Conclusion: According to our findings, majority of admissions with gastroparesis are related with non-diabetic causes with higher healthcare utilization and mortality rate. Gastroparesis is a relatively frequent and poorly understood condition which needs considerate effort to have a better understanding of disease. Presentation: 6/2/2024

6486 Gastroparesis Exacerbation by a GLP-1 Agonist

Abstract Disclosure: J.M. Deirmenjian: None. C. Dagher: None. Gastroparesis is characterized by a delay in gastric emptying that may present with nausea, vomiting, satiety, abdominal pain, and anorexia. The most common cause of gastroparesis is diabetes mellitus due to vagal autonomic neuropathy which prevents coordinated gastric contractions. Medications may also induce gastroparesis. Glucagon-like peptide (GLP)- 1 agonists such as semaglutide are being prescribed for diabetes control but also due to benefits of cardiovascular disease and weight loss. Concerns of GLP-1 agonists causing gastroparesis are valid as the mechanism of action includes delaying gastric emptying, especially with newly developed analogs that are more potent with longer half-lives. Patient is a 43-year-old female with a history of hypertension, uncontrolled diabetes mellitus type 2, diabetic gastroparesis, diabetic neuropathy, hyperlipidemia, and obesity who presented with a one-month history of postprandial abdominal pain, nausea, vomiting, and a 40-pound unintentional weight loss with decreased oral intake. Her abdominal pain was sharp and was exacerbated with eating. While she had several gastroparesis flares in the past, she was in remission for almost two years until she was transitioned from dulaglutide to semaglutide after which she had a recurrent flare after two doses. On physical examination, her abdomen was diffusely tender to palpation.On admission, her hemoglobin A1c was 9.7%. She was made NPO, started on peripheral fluids, and initiated on scheduled metoclopramide given high suspicion of a gastroparesis flare. She underwent a gastric emptying study with the gastric amount retained as follows: 97% (at 1 hour), 88% (at 2 hours), and 79% (at 4 hours). Her hospital course was complicated by persistent symptoms of gastroparesis. Gastroenterology recommended scheduled metoclopramide and erythromycin for motility and dietary adjustments including small volume liquid calories. Her oral intake was insufficient and she opted for total peripheral nutrition until symptoms improved. She was advised to never take a GLP-1 agonist again and should her symptoms not improve the next step would be to pursue a gastric pacemaker. The etiology of the patient’s gastroparesis was uncontrolled diabetes. The proximity between starting semaglutide and symptom onset is compelling as an inciting factor in this flare. This admission’s gastric emptying study results showed higher gastric retention for a longer period of time, which may shed light to the potency of these new GLP-1 analogs. The patient tolerated maximum dose dulaglutide for months but not even two doses of semaglutide. With the race to invent more potent GLP-1 agonists for diabetes control and weight loss on the horizon, knowing their side effects and mechanism of action is crucial. While not listed as a contraindication, there should be hesitancy to offer these agents to anyone with significant gastroparesis. Presentation: 6/2/2024

Diabetic gastroparesis with the marked efficacy of Rikkunshi-to.

Diabetic gastroparesis with the marked efficacy of Rikkunshi-to.

Long-term efficacy (at and beyond 1 year) of gastric peroral endoscopic myotomy for refractory gastroparesis: A systematic review and meta-analysis.

Although gastric peroral endoscopic myotomy (G-POEM) has shown substantial efficacy in patients with medically refractory gastroparesis (GP), comprehensive long-term data on its effectiveness are lacking. We conducted a systematic review and meta-analysis including observational studies assessing long-term efficacy after G-POEM in patients with refractory GP. Our primary outcome was the pooled rate of clinical success 1-year after G-POEM. Secondary outcomes included clinical success at 2 and 3 years and the rate of adverse events according to the American Society for Gastrointestinal Endoscopy classification. Thirteen studies, involving 952 patients with refractory GP undergoing G-POEM, were eligible. The pooled 1 year-clinical success was 0.72 (95% confidence interval [CI]: 0.56, 0.85, I2 = 94.9%). The clinical success was 0.67 (95% CI: 0.47, 0.97, I2 = 95.8%) when considering only studies defining success as 1 point decrease in Gastroparesis Cardinal Symptoms Index score and at least 25% decrease in two subscales. For patients who had 1-year success, the pooled clinical success at 2 and 3 years were 0.71 (95% CI: 0.45, 0.92, I2 = 94.9%) and 0.58 (95% CI: 0.19, 0.92, I2 = 97.1%), respectively. The pooled rate of adverse events was 0.08 (95% CI: 0.06, 0.10, I2 = 0%). G-POEM is associated with successful outcomes in about 70% of treated cases after 1 year, with durable long-term effects lasting up to 3 years. In the future, new uniform outcome definitions and strict patient selection criteria are warranted to delineate G-POEM outcomes more accurately.

S2323 Addressing an Emerging Clinical Need: Nasal Metoclopramide's Impact on Diabetic Gastroparesis in Patients Taking GLP-1 Agonists

S2323 Addressing an Emerging Clinical Need: Nasal Metoclopramide's Impact on Diabetic Gastroparesis in Patients Taking GLP-1 Agonists

S786 The Prevalence of Cardiac Autonomic Neuropathy (CAN) in Diabetic Gastroparesis

S786 The Prevalence of Cardiac Autonomic Neuropathy (CAN) in Diabetic Gastroparesis

S780 Examining the Influence of Food Environment and Socioeconomic Factors on Diabetic Gastroparesis Disease Severity

S780 Examining the Influence of Food Environment and Socioeconomic Factors on Diabetic Gastroparesis Disease Severity

Predicting Response to Neuromodulators or Prokinetics in Patients With Suspected Gastroparesis Using Machine Learning: The "BMI, Infectious Prodrome, Delayed GES, and No Diabetes" Model.

Pharmacologic therapies for symptoms of gastroparesis (GP) have limited efficacy, and it is difficult to predict which patients will respond. In this study, we implemented a machine learning model to predict the response to prokinetics and/or neuromodulators in patients with GP-like symptoms. Subjects with suspected GP underwent simultaneous gastric emptying scintigraphy (GES) and wireless motility capsule and were followed for 6 months. Subjects were included if they were started on neuromodulators and/or prokinetics. Subjects were considered responders if their GP Cardinal Symptom Index at 6 months decreased by ≥1 from baseline. A machine learning model was trained using lasso regression, ridge regression, or random forest. Five-fold cross-validation was used to train the models, and the area under the receiver operator characteristic curve (AUC-ROC) was calculated using the test set. Of the 150 patients enrolled, 123 patients received either a prokinetic and/or a neuromodulator. Of the 123, 45 were considered responders and 78 were nonresponders. A ridge regression model with the variables, such as body mass index, infectious prodrome, delayed gastric emptying scintigraphy, no diabetes, had the highest AUC-ROC of 0.72. The model performed well for subjects on prokinetics without neuromodulators (AUC-ROC of 0.83) but poorly for those on neuromodulators without prokinetics. A separate model with gastric emptying time, duodenal motility index, no diabetes, and functional dyspepsia performed better (AUC-ROC of 0.75). This machine learning model has an acceptable accuracy in predicting those who will respond to neuromodulators and/or prokinetics. If validated, our model provides valuable data in predicting treatment outcomes in patients with GP-like symptoms.

497. ENDOFLIP AND BOTULIN TOXIN INJECTION: THERAPEUTIC MANAGEMENT IN ESOPHAGEAL AND GASTRIC MOTILITY DISORDERS

Abstract Introduction Esophageal motility disorders present diagnostic and therapeutic challenges, with dysphagia being a common symptom prompting evaluation. The Endolumenal Functional Lumen Imaging Probe (EndoFLIP) has recently gained recognition as a valuable tool for assessing esophageal function. This study aims to evaluate the utility of EndoFLIP in guiding therapeutic interventions, specifically focusing on botulinum toxin injections, among patients presenting with diverse esophageal disorders. Moreover, the study acknowledges the potential of EndoFLIP as a diagnostic adjunct during diagnostic upper gastrointestinal endoscopy in cases where therapeutic alternatives are limited or as therapeutic trial. Methods A retrospective analysis was conducted on 21 patients who underwent EndoFLIP assessment and subsequently received botulinum toxin injection at the same procedure. These patients were identified from records at a tertiary center, covering the period from January 2022 to February 2023. EndoFLIP procedures were analyzed, focusing on patient symptoms and indication for the procedure. Data regarding clinical symptoms, EndoFLIP findings, and therapeutic interventions were extracted and analyzed to assess the role of EndoFLIP in guiding treatment decisions for esophageal disorders. The used cutoffs for esophagogastric junction (EGJ) distensibility index were &amp;lt; 2 mm2/mmHg and &amp;lt; 10 mm2/mmHg for pyloric distensibility. Results All patients referred for esophageal motility evaluation with EndoFLIP presented with dysphagia as the primary symptom. Two patients presented with postprandial bloating, leading to further evaluation with impedance planimetry to assess pyloric distensibility, suspected to be due to diabetic gastroparesis. Following EndoFLIP assessment, a conclusive diagnosis was achieved in all patients: 10 patients were diagnosed with esophagogastric junction outflow obstruction, 1 patient with absent contractility, 7 patients with achalasia, and 1 patient with hypercontractile esophagus. Patients who underwent planimetry to evaluate pyloric distensibility both exhibited reduced distensibility index. Following treatment, 10 patients showed clinical improvement and 11 await clinical reassessment. Conclusions Regarding the evaluation of the EGJ distensibility index in patients with achalasia without indication for invasive treatment, the EndoFLIP emerges as a diagnostic tool that allows for immediate guidance if intervention is recommended. Likewise, patients with refractory gastroparesis and pylorospasm identified through EndoFLIP may benefit from toxin injection for future myotomy decision. In conclusion, EndoFLIP serves as a valuable tool in diagnosing and guiding therapeutic interventions in patients with esophageal and gastric motility disorders. Further research is warranted to validate the role of EndoFLIP in optimizing treatment outcomes for esophageal disorders.

Diabetic Gastroparesis: Diagnosis, Management, and Future Perspectives

Gastroparesis, a complication of diabetes, is characterized by delayed gastric emptying without obstruction. It arises from chronic hyperglycemia-induced damage to the autonomic and enteric nervous systems, manifesting primarily as nausea, vomiting, early satiety, and bloating. This condition severely impacts quality of life and glycemic control, increasing the risk of further diabetes-related complications. Early diagnosis and treatment are essential, involving stringent glycemic control, lifestyle changes, pharmacological therapy, and sometimes surgical interventions. Diagnostic approaches include ruling out other causes, followed by tests like scintigraphy, radiological examination, and breath tests. Treatment begins with dietary modifications and, if necessary, progresses to enteral or parenteral nutrition. Glycemic management is crucial, with specific medications either recommended or contraindicated. Pharmacological treatments include metoclopramide and domperidone, though both have significant side effects. Emerging therapies involve ghrelin and motilin agonists, and antidepressants like mirtazapine. Gastric electrical stimulation, endoscopic, and surgical procedures offer additional treatment avenues for severe cases. Effective management of gastroparesis can substantially improve patient outcomes and long-term diabetes management.

Diabetic Gastroparesis: Epidemiology, Pathophysiology, Symptoms, and Clinical Consequences

Diabetes mellitus affects over half a billion people worldwide and is associated with numerous complications, including diabetic gastroparesis, characterized by delayed gastric emptying without mechanical obstruction. Although diabetic gastroparesis does not affect life expectancy, it significantly impairs digestion and medication absorption, complicating glucose metabolism and health management, thus reducing quality of life. The etiology of diabetic gastroparesis is multifactorial, involving autonomic neuropathy, vagus nerve dysfunction, disturbances in interstitial cells of Cajal, nitric oxide synthesis, hyperglycemia, and oxidative stress. Symptoms include early satiety, bloating, nausea, vomiting, dysphagia, and unintentional weight loss, which complicate diabetes management by causing unpredictable glycemic control. Despite advancements in understanding diabetic gastroparesis, it remains underdiagnosed due to its often asymptomatic nature. Further research is needed to elucidate its epidemiology and pathophysiology, particularly in asymptomatic patients. This review discusses the epidemiology, pathophysiology, symptoms, and clinical consequences of diabetic gastroparesis, highlighting the need for improved diagnostic and management strategies.

Research Progress on Traditional Chinese Medicine Classification and Treatment of Diabetic Gastroparesis

Research Progress on Traditional Chinese Medicine Classification and Treatment of Diabetic Gastroparesis

Abdominal Pain and Chronic Opiate Use in Patients with Gastroparesis

Introduction: Although opiate narcotics may worsen gastroparesis(GP), patients can take these for abdominal pain (AP) or other chronic pain syndromes. This study aims to evaluate medications patients with gastroparesis use for AP and compare patients who use opiate analgesics for AP to those using opiate analgesics for non-abdominal pain. Methods: Patients at a tertiary academic center gastroenterology clinic completed the Patient Assessment of Gastrointestinal Disorders–Symptom Severity Index (PAGI-SYM) and Quality of Life Short-Form 8 (QOL SF-8) surveys between 10/2021 and 03/2023. Patients recorded gastroparesis treatments, pain treatments and indication, and any hospitalizations/emergency department (ED) visits within 3 months of a clinic visit. Results: A total of 53 patients were enrolled: 72% reported having AP. Patients were using the following medications for AP: 25% heating pad, ice or hot showers, 20.8% acetaminophen, 14.6% hyoscyamine, 13% opiate use, 13% marijuana use, 10.4% dicyclomine, 8.3% Nonsteroidal anti-inflammatory drugs (NSAIDs), 4% benzodiazepine, and 2.1% gabapentin. The reported reasons for using opiates were 58% AP, 16.6% chronic back pain, 16.6% Reflex Sympathetic Dystrophy (RSD) and fibromyalgia, and 8.3% osteoarthritis. All opiate users reported daily scheduled use. AP severity scores (4.1 vs. 2.8; p = 0.041), morphine equivalent usage (77 ± 44 vs. 32 ± 28; p = 0.037), and the number of ER visits (1.0 vs. 0 over 3 months) were higher in patients using opiates for AP than those using opiates for non-abdominal pain. Conclusions: In this series, 72% of patients with gastroparesis had abdominal pain, and 13% of patients were taking opiates. Patients who used opiate analgesics for abdominal pain had a higher average abdominal pain severity score and used a higher amount of opiate analgesia than patients using opiates for musculoskeletal pain. Abdominal pain in patients with gastroparesis can be harder to control with opiate analgesia compared to non-abdominal pain, supporting the concept of avoiding chronic opiate usage for abdominal pain in gastroparesis.

Outcome of gastric electrical stimulator with and without pyloromyotomy for refractory gastroparesis

BackgroundSurgical treatments of refractory gastroparesis include pyloromyotomy and gastric electrical stimulator (GES). It is unclear if patients may benefit from a combined approach with concomitant GES and pyloromyotomy.MethodsRetrospective cohort analysis of all patients with refractory gastroparesis treated with GES implantation with and without concomitant pyloromyotomy at Cleveland Clinic Florida from January 2003 to January 2023. Primary endpoint was efficacy (clinical response duration and success rate) and secondary endpoints included safety (postoperative morbidity) and length of stay. Success rate was defined as the absence of one of the following reinterventions during follow-up: Roux-en-Y gastric bypass (RYGB), pyloromyotomy, GES removal.ResultsDuring a period of 20 years, 134 patients were treated with GES implantation. Three patients with history of previous surgical pyloromyotomy or RYGB were excluded from the analysis. Median follow-up was 31 months (IQR 10, 72). Forty patients (30.5%) had GES with pyloromyotomy, whereas 91 (69.5%) did not have pyloromyotomy. Most of the patients had idiopathic (n = 68, 51.9%) or diabetic (n = 58, 43.3%) gastroparesis. Except for preoperative use of opioids (47.5 vs 14.3%; p < 0.001), patient’s characteristics were similar in both groups. There were no significant differences between the two groups in terms of overall postoperative complications (17.5% vs 14.3%; p = 0.610), major postoperative complications (0% vs 2.2%; p = 1), and length of stay (2(IQR 1, 2) vs 2(IQR 1, 3) days; p = 0.068). At 5 years, success rate was higher in patients with than without pyloromyotomy however not statistically significant (82% versus 62%, p = 0.066). Especially patients with diabetic gastroparesis seemed to benefit from pyloromyotomy during GES (100% versus 67%, p = 0.053). In an adjusted Cox regression, GES implantation without pyloromyotomy was associated with a 2.66 times higher risk of treatment failure compared to GES implantation with pyloromyotomy (HR 2.66, 95% CI 1.03–6.94, p = 0.044).ConclusionPyloromyotomy during GES implantation for gastroparesis seems to be associated with a longer clinical response with similar postoperative morbidity and length of hospital stay than GES without pyloromyotomy. Patient with diabetic gastroparesis might benefit from a combination of GES implantation and pyloromyotomy.