Gastroparesis Severity Research Articles

Gastroparesis-Related Symptoms in Patients With Type 2 Diabetes Mellitus: Early Detection, Risk Factors, and Prevalence.

Background The symptoms of gastroparesis, such as bloating, postprandial fullness, early satiety, nausea, and abdominal discomfort, progressively worsen the quality of life of the affected individuals. The diagnosis is established on the assessment of gastric function that confirms delayed gastric emptying in the absence of structural etiologies. This study aimed to detect gastroparesis-related clinical symptoms early in patients with type 2 diabetes mellitus (T2DM), investigate the concomitant risk factors, and evaluate the prevalence. Methodology This study was conducted at the Department of Medicine and Diabetes Outdoor Clinic of Sheikh Zayed Hospital, Rahim Yar Khan from February 13, 2022, to February 11, 2023. The study involved 175 patients with T2DM who reported gastroparesis-related symptoms. The demographic and clinical characteristics, symptom severity, complications, related risk factors, duration of disease, medications, body mass index (BMI), fasting plasma glucose, and glycated hemoglobin (HbA1C) levels were assessed. The severity of diabetic gastroparesis was established using the disease-specific Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) and the Gastroparesis Cardinal Symptom Index (GCSI). The five-point scale of the PAGI-SYM and the four-degree severity scores of GCSI were assessed. Neuropathy disability scores and motor evacuation functions were analyzed. Data were analyzed from these questionnaires, special proforma, and patient interviews. Results The clinical features of diabetic gastroparesis were observed in 44% of T2DM patients with mild-grade gastroparesis in 38 (21.7%), moderate in 30 (17.1%), and severe-grade gastroparesis-related symptoms in nine (5.2%) patients. The main manifestations were early satiety (45.1%), stomach fullness (44.5%), bloating (38.3%), and nausea (33.1%). Diabetic gastroparesis symptoms were considerably linked to disease duration of more than 10 years (p = 0.02), high HbA1c (p = 0.001), increased fasting blood glucose (p = 0.003), polyneuropathy, cigarette smoking, and history of comorbid conditions (p = 0.009). Obesity and the female gender were the forecasters of the manifestation of at least one cardinal gastroparesis symptom. Conclusions Gastric emptying is significant in the pathogenesis of gastroparesis-related symptoms. Disease duration of more than 10 years, poor glycemic control with hyperglycemia, high HbA1C, polyneuropathy, and cigarette smoking must be considered as predictors for early detection and risk factors for the advancement of gastroparesis in T2DM. Gastroparesis-related common symptoms of early satiety, bloating, and stomach fullness were considerably linked to the additional risk factors of hypercholesteremia, chronic microvascular complications, concomitant cardiovascular diseases, and a positive family history of diabetes mellitus. There was no relationship between BMI, age, types of treatment, and the degree of gastroparesis severity. The prevalence and severity of gastroparesis symptoms were particularly high among obese females with poor glycemic control and longer disease duration.

Laparoscopic Toupet Fundoplication for Lung Transplant Recipients: Outcomes and Effects on Symptoms

INTRODUCTION: Lung transplant (LTx) recipients often experience GERD, which predisposes them to bronchiolitis obliterans syndrome and obstructive chronic lung allograft dysfunction, ultimately resulting in early rejection and death. Laparoscopic Nissen fundoplication (LNF) has historically been the procedure of choice for LTx-related GERD. However, LNF is associated with high rate of postoperative dysphagia and bloating in the general population. Hence, we evaluate laparoscopic Toupet fundoplication (LTF) as an option for antireflux surgery in LTx recipients, investigating the effects of LTF on DeMeester score, gastric emptying, esophageal manometry, and patient symptoms. METHODS: A retrospective review of LTx patients who underwent LTF at a single center by 1 surgeon (n = 59) between September 2018 and November 2020 was performed, excluding a patient who had a revision of their fundoplication. Preoperative and postoperative esophageal manometry, gastric emptying studies, and patient-reported GERD symptoms were collected. Statistical analyses were performed using Prism 9 Version 9.3.1 for macOS, GraphPad Software. RESULTS: After LTF, DeMeester score and relative risk of abnormal esophageal function and gastroparesis were significantly decreased, with most patients having lower gastroparesis severity score. Reports of heartburn, regurgitation, and bloating were also reduced. However, the rates of dysphagia were similar. There was no decline in pulmonary function. CONCLUSION: LTF, in addition to providing antireflux control in LTx recipients, has low rate of complication and trends with overall improvement of gastrointestinal issues. LTF ultimately has the potential to be the antireflux operation of choice in LTx recipients, protecting against early rejection and death.

Gastroparesis in systemic sclerosis: a detailed analysis using whole-gut scintigraphy.

Gastroparesis is a common complication of SSc. We sought to determine the degree of overlap between gastroparesis and dysmotility in other areas of the gut, correlate our findings with gastrointestinal (GI) symptoms, and examine associations between gastroparesis and SSc features. Whole-gut scintigraphy was performed on SSc patients who were enrolled in the Johns Hopkins Scleroderma Cohort, for whom detailed longitudinal clinical and serologic data are collected. A subset of patients completed the University of California Los Angeles Scleroderma Clinical Trial Consortium Gastrointestinal Tract Instrument 2.0 (UCLA GIT 2.0) to quantify their GI symptoms. We examined associations between the presence and severity of gastroparesis, GI symptoms, and SSc clinical features. Ninety-seven SSc patients with and without GI symptoms underwent whole-gut scintigraphy and completed the gastric emptying study. Of the 97, 34 (35%) met criteria for gastroparesis. Of the measures assessed, delayed liquid emptying captured more patients with delayed gastric transit than delayed solid emptying (74% vs 55%), and percentage liquid emptying correlated best with GIT Reflux (ρ = -0.33, P = 0.01) and Distension (ρ = -0.30, P = 0.03) scores. Of 33 patients with gastroparesis, 30 (91%) had abnormal transit in other areas of the GI tract. Higher anti-centromere protein B (CENP-B) titres correlated with slower gastric emptying (ρ = -0.26, P = 0.03), but no specific clinical features of SSc were associated with gastroparesis. Gastric emptying of liquids when given alongside solids may be more sensitive and provide a more clinically relevant measure of gastroparesis in SSc than solid gastric emptying or liquid gastric emptying alone. SSc patients with gastroparesis frequently have dysmotility in other areas of the GI tract, underscoring the need for whole-gut scintigraphy to evaluate the entire gut.

S1396 Glycosylated Hemoglobin Relation With Gastric Emptying Study in Gastroparesis

Introduction: Gastroparesis is a debilitating disorder which includes several upper abdominal symptoms and documented slow gastric emptying (AJG 2013; 108:18). Past studies have shown heterogenous results of correlations between the glycemic control and the gastric emptying study. We aim to study the association of glycosylated hemoglobin (HbA1c) with gastric emptying. Methods: We performed retrospective review of the patients diagnosed with diabetic gastroparesis between September 30th, 2009 and January 31st, 2020. The 99mTc sulfur labeled food study was used to diagnose gastroparesis. Gastric emptying of < 90% for solids at 240 minutes and < 95% for liquids at 60 minutes were identified as delayed gastric emptying. We examined the relationship of HbA1c levels with the rate of gastric emptying examined by various gastric emptying test. The cohort was further divided into HbA1c levels < 7% (good diabetes control), 7-9% (fair diabetes control) and >9% (poor diabetes control). Results: There were 129 patients (mean age 51.1 ± 14.2 years, 61.8% female, 64.1% white) with diabetic gastroparesis. The mean HbA1c level was 8.3 ± 2.2 %. We observed that the HbA1c levels were not associated with level of gastric emptying with either solid (r=-0.12, p=0.28) or liquid study (r=-0.15, p=0.17). The mean gastric emptying was 74.3 ± 20.9% for solids and 67.9 ± 23.6 % for liquids with good glycemic control, 70.8 ± 20.1 % for solids and 52.3 ± 31.1 % for liquids in patients with fair diabetes control and 64.4 ± 26.7 % for solids and 52.9 ± 31 % for liquids in the patients with poorly controlled diabetes mellitus. The level of glycemic control did not predict the percentage of solid gastric emptying (p=0.29) whereas there was trend towards inverse relation with liquids (p=0.09). Conclusion: There is no correlation between the HbA1c levels and gastric emptying time. The level of diabetes mellitus control does not predict the severity of gastroparesis at the time of diagnosis.Figure 1.: A. Correlation of HbA1c levels with liquid gastric emptying at 60 minutes, B. Correlation of HbA1c levels with solid gastric emptying at 240 minutes, C. Glycemic control category and gastric emptying studies (240 min solid and 60 min liquid).Table 1.: Patients’ characteristic and comparison of diabetic gastroparesis with diabetic non-gastroparesis.

Beyond Metoclopramide for Gastroparesis

Beyond Metoclopramide for Gastroparesis

The impact of risk factors on gastroparesis at an urban medical center.

BackgroundGastroparesis is a complex and poorly understood disease. The literature is lacking with respect to the epidemiology of patient comorbidities and their effect on gastric emptying. We aimed to describe the most common comorbid conditions among patients with gastroparesis in an urban population and quantify the effect of these comorbidities on the severity of delayed gastric emptying (DGE).MethodsWe examined the medical records of all patients diagnosed with gastroparesis at a quaternary care center between 2014 and 2015. The severity of DGE was analyzed after patients were stratified for possible causative etiologies. Likelihood ratio tests were used to assess the significance of demographic and scintigraphic variation in this population.ResultsOf the 221 patients, 56.1% were Caucasian and 31.7% were African American. Among these patients, 29.4% had evidence of medication-associated gastroparesis, 29.0% had diabetes-associated gastroparesis, and 31.7% had idiopathic disease. African American patients with gastroparesis were more likely to have diabetic gastroparesis than patients of other races (P=0.01). There was a statistically significant relationship between the number of major risk factors and the severity of a patient’s DGE (P=0.004).ConclusionsAmong a diverse urban population, patients with DGE often carry multiple comorbid conditions that serve as risk factors for the development of gastroparesis, including prescriptions for narcotic medications. Greater numbers of these comorbid conditions are associated with more severe disease. Demographics are significantly associated with the etiology and severity of gastroparesis; in particular, African American patients are more likely to have diabetic gastroparesis than patients of other races.

Is gastroparesis a gastric disease?

Gastroparesis is a digestive syndrome characterized by delayed gastric emptying (GE) and by symptoms that are suggestive of gastroduodenal motor disorders. There are three grades of gastroparesis of increasing severity: (a) mild gastroparesis; (b) compensated gastroparesis; and (c) gastric failure. GE abnormalities are partially related to symptom type and severity, and other mechanisms may be involved. To investigate enteric dysmotility (ED) in patients with suspected gastroparesis. Patients with symptoms suggestive of gastroparesis were consecutively included in the study and underwent a 13 C-octanoic acid GE breath test and small bowel manometry (SBM). Clinical features were recorded using predefined, validated questionnaires at entry. The study enrolled 88 patients (71 women; mean age: 37.8±14.3years). Gastric emptying was delayed in 25 patients (28.4%), and 70 patients (79.5%) presented small bowel motor abnormalities including bursts, abnormal activity fronts, inability to respond to meal ingestion, and hypocontractility. Gastric emptying was delayed in 24 of the 70 patients with ED (34.3% vs 5.5% of patients with normal SBM). Enteric dysmotility was detected in 24 of 25 patients (96%) with delayed GE. Patients with and without delayed GE showed similar moderate/severe gastroparesis manifestations, but patients with ED significantly more often had moderate/severe gastroparesis manifestations than patients with normal SBM (grade 1:14% vs 39%, grade 2:62% vs 56%, grade 3:24% vs 5%, respectively). Enteric dysmotility was more frequent than delayed GE in patients with symptoms suggestive of gastroparesis. Gastroparesis severity was associated with small bowel motor abnormalities but not with delayed GE.

Does the Solid Meal Utilized in a Standard Scintigraphic Gastric Emptying Test Induce Symptoms That Correlate With the Degree of Delayed Gastric Emptying in Patients With Gastroparesis?: Presidential Poster Award

Introduction: A debated question in gastroparesis (GP) is whether the severity of isotope retention determines the variance in symptoms. Hence, our aim was to assess if the severity of symptoms induced by a standard radiolabeled eggbeater meal could distinguish the categories of food retention in GP. Methods: Patients with symptoms suggesting an upper GI motility disorder underwent a scintigraphic gastric emptying (GE) test. GP patients were categorized as mild, moderate, severe and very severe based on percent isotope retention at 4 hrs: 10-20%, 20-35%, 35-50% and >50%, respectively. Symptoms of nausea, fullness, bloating and abdominal pain were graded from 0-4 (none, minimum, mild, moderate and severe) by questioning the patient prior to, immediately after the meal, and hourly over the 4 hrs. Adjusted association between GP severity and symptoms were assessed using repeated logistic regression analysis. Results: 103 GP patients were recruited, average age of 50 [range: 18 - 86] and 75% females. The gastric retention in the majority of the patients was mild (36%) and very severe patient (33%), followed by moderate (23%) and severe (8%). Of the 103 GP patients, 42% had diabetes (DM) with the very severe gastric retention group having the highest percentage of DM (45%). After adjusting for diabetes, moderate retention patients were more likely to experience more nausea and bloating symptoms (Figures 1 and 2) (OR: 2.03, p=0.108; OR: 2.27, p=0.08), while very severe were less likely to experience bloating and abdominal pain (OR: 0.47, p=0.09; OR: 2.43, p=0.06) when compared to the mild gastric retention group. Moreover, DM patients had a statistical increase in the likelihood of experiencing nausea over nondiabetics (OR: 1.17, p=0.104; OR: 1.98, p=0.04). Fullness increased postprandially with no significant differences observed among the groups<./p>420_A Figure 1. Nausea in GP patients across the 4-hr meal420_B Figure 2. Bloating in GP patients across the 4-hr mealConclusion: We conclude that after a standard GE test meal: 1) nausea and bloating best correlate with a moderate gastric retention severity status (20-35%) and postprandial fullness is increased in all retention categories; 2) DM patients had greater nausea sensitivity; 3) There is disparity between very severe gastric retention (>50%) and decreased symptom severity, particularly with abdominal pain. Explanations include a chronically distended antrum being unable discriminate postprandial symptoms, the eggbeater test meal is insufficient in volume to provoke symptoms, and both DM and non-DM etiologies impair gastric neurosensory function.

Gastric peroral endoscopic myotomy for the treatment of refractory gastroparesis: a multicenter international experience.

Gastroparesis is a difficult-to-treat motility disorder with a poor response to medical therapy. Gastric peroral endoscopic pyloromyotomy (G-POEM) has been offered as a novel therapy in the treatment of refractory gastroparesis. We present a multicenter case series of our experience with G-POEM. This is an international multicenter case series of patients who underwent G-POEM for the treatment of gastroparesis. The severity of gastroparesis was assessed by delayed gastric emptying scintigraphy (GES) and an elevated gastroparesis cardinal symptoms index (GCSI). Patients then underwent G-POEM using the submucosal tunneling technique. The primary endpoint was improvement in the GCSI score and improvement in gastric emptying on repeat scintigraphy. Secondary endpoints were technical success, complication rate, procedure duration, and length of hospital stay post-procedure. G-POEM was technically successful in all 33 patients. Symptomatic improvement was seen in 28/33 patients (85 %), with a decrease in symptom score by GCSI from 3.3 to 0.8 at follow-up (P < 0.001). The mean procedure duration was 77.6 minutes (37 - 255 minutes). Mean GES improved significantly from 222.4 minutes to 143.16 minutes (P < 0.001). Complications were minimal and included bleeding (n = 1) and an ulcer (n = 1) treated conservatively. The mean length of hospital stay post-procedure was 5.4 days (1 - 14 days). The mean follow-up duration was 11.5 months (2 - 31 months). G-POEM is a technically feasible, safe, and successful procedure for the treatment of refractory gastroparesis. A further multicenter comparative study should be performed to compare this technique to laparoscopic pyloromyotomy.

Glycosylated hemoglobin level may predict the severity of gastroparesis in diabetic patients

AimTo investigate the association between glycemic control represented by glycated hemoglobin (HbA1c) level and the value of 4-h gastric retention on nuclear scan. MethodsWe retrospectively reviewed records of diabetic patients who had 4-h nuclear gastric emptying study, with documented 4-h retention value, between January 1st, 2002 and July 30th, 2014 and had HbA1C level close to the time of the study. We divided our cohort into patients with good glycemic control (HbA1C <7, group A), fair control (7–9, group B), and poor control (>9, group C). The 4-h retention value and symptoms were compared between the 3 groups. ResultsOur cohort included 299 patients; mean age was 59 ± 14. The median interval between performing gastric emptying study and measuring HbA1C was 41 days. There were 94 patients in group A (HbA1C 6.1 ± 0.4), 131 patients in group B (HbA1C 7.9 ± 0.5), and 74 patients in group C (HbA1C 10.9 ± 1.6). The mean gastric retention value was different between the three study groups, 8.3% ±17, 11.5% ±19, and 14.4% ±21, respectively (P = .03). ConclusionThis is the first study to show that HbA1C level is significantly associated with the 4-h retention value on nuclear gastric emptying scan.

Early satiety and postprandial fullness in gastroparesis correlate with gastroparesis severity, gastric emptying, and water load testing.

Early satiety (ES) and postprandial fullness (PPF) are often present in gastroparesis, but the importance of these symptoms in gastroparesis has not been well-described. The aims were: (i) Characterize ES and PPF in patients with gastroparesis. (ii) Assess relationships of ES and PPF with etiology of gastroparesis, quality of life, body weight, gastric emptying, and water load testing. Gastroparetic patients filled out questionnaires assessing symptoms (PAGI-SYM) and quality of life (PAGI-QOL, SF-36v2). Patients underwent gastric emptying scintigraphy and water load testing. 198 patients with gastroparesis (134 IG, 64 DG) were evaluated. Early satiety was severe or very severe in 50% of patients. Postprandial fullness was severe or very severe in 60% of patients. Severity scores for ES and PPF were similar between idiopathic and diabetic gastroparesis. Increasing severity of ES and PPF were associated with other gastroparesis symptoms including nausea/vomiting, satiety/early fullness, bloating, and upper abdominal pain and GERD subscores. Increasing severity of ES and PPF were associated with increasing gastroparesis severity, decreased BMI, decreased quality of life from PAGI-QOL and SF-36 physical health. Increasing severity of ES and PPF were associated with increasing gastric retention of a solid meal and decreased volume during water load test. Early satiety and PPF are commonly severe symptoms in both diabetic and idiopathic gastroparesis. Early satiety and PPF severity are associated with other gastroparesis symptom severities, body weight, quality of life, gastric emptying, and water load testing. Thus, ES and PPF are important symptoms characterizing gastroparesis. ClinicalTrials.gov number: NCT NCT01696747.

1081 Early Satiety and Postprandial Fullness in Gastroparesis Correlate With Gastroparesis Severity, Gastric Emptying, and Water Load Testing

1081 Early Satiety and Postprandial Fullness in Gastroparesis Correlate With Gastroparesis Severity, Gastric Emptying, and Water Load Testing

Quantifying the "Slosh Stomach": A Novel Tool for Assessment of Exercise-Associated Gastroparesis Symptoms in Endurance Athletes.

Introduction. We describe a novel scale and its field use for evaluation of exercise-associated gastroparesis in the endurance athlete. Methods. A scale was created based on gastroparesis tools previously described in the medical literature. Surveys of the tool were administered to runners participating in a 210 km multiday foot race in Sri Lanka. Results. Use of this novel scale was demonstrated to be useful in assessing gastroparesis severity scores of athletes and how these symptoms affected their race performance. Of the 27 race participants who completed the survey, 27 felt that the tool adequately captured their symptoms. Conclusions. This novel survey tool was able to assess the presence and severity of exercise-associated gastroparesis symptoms in endurance racers in a remote location. This tool may be helpful with further research of the identification and management of gastroparesis and other gastrointestinal upset in the endurance race environment.

Can Glycosylated Hemoglobin (HbA1C) Predict the Severity of Gastroparesis in Diabetic Patients? Presidential Poster

Can Glycosylated Hemoglobin (HbA1C) Predict the Severity of Gastroparesis in Diabetic Patients? Presidential Poster

Factors related to abdominal pain in gastroparesis: contrast to patients with predominant nausea and vomiting

Factors associated with abdominal pain in gastroparesis are incompletely evaluated and comparisons of pain vs other symptoms are limited. This study related pain to clinical factors in gastroparesis and contrasted pain/discomfort- with nausea/vomiting-predominant disease. Clinical and scintigraphy data were compared in 393 patients from seven centers of the NIDDK Gastroparesis Clinical Research Consortium with moderate-severe (Patient Assessment of Upper Gastrointestinal Disorders Symptoms [PAGI-SYM] score ≥ 3) vs none-mild (PAGI-SYM < 3) upper abdominal pain and predominant pain/discomfort vs nausea/vomiting. Upper abdominal pain was moderate-severe in 261 (66%). Pain/discomfort was predominant in 81 (21%); nausea/vomiting was predominant in 172 (44%). Moderate-severe pain was more prevalent with idiopathic gastroparesis and with lack of infectious prodrome (P ≤ 0.05) and correlated with scores for nausea/vomiting, bloating, lower abdominal pain/discomfort, bowel disturbances, and opiate and antiemetic use (P < 0.05), but not gastric emptying or diabetic neuropathy or control. Gastroparesis severity, quality of life, and depression and anxiety were worse with moderate-severe pain (P ≤ 0.008). Factors associated with moderate-severe pain were similar in diabetic and idiopathic gastroparesis. Compared to predominant nausea/vomiting, predominant pain/discomfort was associated with impaired quality of life, greater opiate, and less antiemetic use (P < 0.01), but similar severity and gastric retention. Moderate-severe abdominal pain is prevalent in gastroparesis, impairs quality of life, and is associated with idiopathic etiology, lack of infectious prodrome, and opiate use. Pain is predominant in one fifth of gastroparetics. Predominant pain has at least as great an impact on disease severity and quality of life as predominant nausea/vomiting.

Clinical Features of Idiopathic Gastroparesis Vary With Sex, Body Mass, Symptom Onset, Delay in Gastric Emptying, and Gastroparesis Severity

Clinical Features of Idiopathic Gastroparesis Vary With Sex, Body Mass, Symptom Onset, Delay in Gastric Emptying, and Gastroparesis Severity

Management of diabetic gastroparesis

Symptoms suggestive of gastroparesis occur in 5% to 12% of patients with diabetes. Such a complication can affect both prognosis and management of the diabetes; therefore, practicing clinicians are challenged by the complex management of such cases. Gastroparesis is a disorder characterized by a delay in gastric emptying after a meal in the absence of a mechanical gastric outlet obstruction. This article is an evidence-based overview of current management strategies for diabetic gastroparesis. The cardinal symptoms of diabetic gastroparesis are nausea and vomiting. Gastroesophageal scintiscanning at 15-minute intervals for 4 hours after food intake is considered the gold standard for measuring gastric emptying. Retention of more than 10% of the meal after 4 hours is considered an abnormal result, for which a multidisciplinary management approach is required. Treatment should be tailored according to the severity of gastroparesis, and 25% to 68% of symptoms are controlled by prokinetic agents. Commonly prescribed prokinetics include metoclopramide, domperidone, and erythromycin. In addition, gastric electrical stimulation has been shown to improve symptoms, reduce hospitalizations, reduce the need for nutritional support, and improve quality of life in several open-label studies.

Does Grading the Severity of Gastroparesis Based on Scintigraphic Gastric Emptying Predict the Treatment Outcome of Patients with Gastroparesis?

The objectives of this study were as follows: (1) Whether gastric emptying is different between gastroparesis (GP) patients responding or not responding to standard medical therapy; (2) Identifying if mild, moderate, and severe degrees of gastroparesis based on the scintigraphic gastric emptying test (GET) can predict treatment responses for GP of diabetic (DM) and idiopathic (ID) origin. A total of 165 patients (119 F) diagnosed with GP [126 (76%) DM, 39 (24%) ID etiology] failed medical treatment and required the gastric electrical stimulation (GES) device (GES group). In addition, 112 patients (89 F) [37 (33%) DM, 75 (67%) ID] with GP who symptomatically responded to medical therapies are the comparison group (MED GP). All patients underwent a standardized scintigraphic GET consisting of low-fat (2%) isotope labeled egg beaters meal of 250 kcal. We also analyzed the GET data to find cut-off points for different degrees of GP and identified mild (11-20% retention), moderate (21-35%), and severe gastroparesis (>35%) based on percent retention of isotope at 4 h. Overall gastric retention at 4 h was significantly greater in the GES group (45±1.9%) than MED GP (30±2%) (p<0.001). The distribution severity of the GET was different in GES-treated patients than MED treated (p<0.001). In the diabetics, 57% of GES patients retained >35% after 4 h (severe) similar to 43% in the DM MED group. However, 50% of the ID GES patients had retention>35% at 4 h significantly more than only 17% of ID MED GP. Significantly more ID patients who responded to medical therapy had mild gastroparesis and significantly more requiring GES had severe GET (p<0.05). (1) GET in patients whose GP symptoms were refractory to standard medical therapy and required GES was significantly slower than in GP patients whose symptoms responded to medical therapy. (2) Stratifying GET into mild, moderate, and severe degrees of gastric retention does not predict whether a medical or surgical approach will be better to control the symptoms of diabetic GP but does correlate with treatment for the idiopathic GP subgroup.

Clinical Features of Idiopathic Gastroparesis Vary With Sex, Body Mass, Symptom Onset, Delay in Gastric Emptying, and Gastroparesis Severity

Idiopathic gastroparesis (IG) is a common but poorly understood condition with significant morbidity. We studied characteristics of patients with IG enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Registry. Data from medical histories, symptom questionnaires, and 4-hour gastric emptying scintigraphy studies were obtained from patients with IG. The mean age of 243 patients with IG studied was 41 years; 88% were female, 46% were overweight, 50% had acute onset of symptoms, and 19% reported an initial infectious prodrome. Severe delay in gastric emptying (>35% retention at 4 hours) was present in 28% of patients. Predominant presenting symptoms were nausea (34%), vomiting (19%), an abdominal pain (23%). Women had more severe nausea, satiety, constipation, and overall gastroparesis symptoms. Patients who experienced acute-onset IG had worse nausea than those with insidious onset. Overweight patients had more bloating and gastric retention at 2 hours but less severe loss of appetite. Patients with severely delayed gastric emptying had worse vomiting and more severe loss of appetite and overall gastroparesis symptoms. Severe anxiety and depression were present in 36% and 18%, respectively. A total of 86% met criteria for functional dyspepsia, primarily postprandial distress syndrome. IG is a disorder that primarily affects young women, beginning acutely in 50% of cases; unexpectedly, many patients are overweight. Severe delay in gastric emptying was associated with more severe symptoms of vomiting and loss of appetite. IG is a diverse syndrome that varies by sex, body mass, symptom onset, and delay in gastric emptying.

Psychological Dysfunction Is Associated With Symptom Severity but Not Disease Etiology or Degree of Gastric Retention in Patients With Gastroparesis

Gastroparesis patients may have associated psychological distress. This study aimed to measure depression and anxiety in gastroparesis in relation to disease severity, etiology, and gastric retention. Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) scores for state (Y1) and trait (Y2) anxiety were obtained from 299 gastroparesis patients from 6 centers of the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium. Severity was investigator graded as grades 1, 2, or 3 and patient reported by Gastroparesis Cardinal Symptom Index (GCSI) scores. Antiemetic/prokinetic medication use, anxiolytic and antidepressant medication use, supplemental feedings, and hospitalizations were recorded. BDI, Y1, and Y2 scores were compared in diabetic vs. idiopathic etiologies and mild (≤20%) vs. moderate (>20-35%) vs. severe (>35-50%) vs. very severe (>50%) gastric retention at 4 h. BDI, Y1, and Y2 scores were greater with increasing degrees of investigator-rated gastroparesis severity (P<0.05). BDI, Y1, and Y2 scores were higher for GCSI >3.1 vs. ≤3.1 (P<0.05). Antiemetic and prokinetic use and ≥6 hospitalizations/year were more common with BDI ≥20 vs. <20 (P<0.05). Anxiolytic use was more common with Y1≥46; antidepressant use and ≥6 hospitalizations/year were more common with Y2≥44 (P<0.05). BDI, Y1, and Y2 scores were not different in diabetic and idiopathic gastroparesis and did not relate to degree of gastric retention. On logistic regression, GCSI >3.1 was associated with BDI ≥20 and Y1≥46; antiemetic/prokinetic use was associated with BDI≥20; anxiolytic use was associated with Y1≥46; and antidepressant use was associated with Y2≥44. Higher depression and anxiety scores are associated with gastroparesis severity on investigator- and patient-reported assessments. Psychological dysfunction does not vary by etiology or degree of gastric retention. Psychological features should be considered in managing gastroparesis.