Upper Gastrointestinal Symptoms Research Articles

A study to assess the effectiveness of ginger tea on symptoms of dyspepsia among adults

Introduction: Dyspepsia is a common gastrointestinal (GI) condition around the world. Dyspepsia is a symptom complex that includes a variety of upper GI symptoms such as epigastric pain or burning, early satiety, and post-prandial fullness. Treatment with complementary and alternative medicines, particularly herbal remedies, is one option for treating dyspepsia symptoms. Objectives: The objectives of the study were to evaluate the effectiveness of ginger tea on symptoms of dyspepsia among adults Methods: A one-group pre-test and post-test research design with 30 samples who met the inclusion criteria was used. Demographic and clinical data were collected using a self-structured questionnaire. During the pre-test, a questionnaire (LDQ) was used to assess the severity of dyspepsia symptoms using an interview method. Following the pre-test, 100ml of freshly prepared ginger tea was given once a day, seven days a week, in the morning before meals. The same tool was used for the post-test after seven days of ginger tea administration. Data has been subjected to descriptive and inferential statistics Result: During the pre-test, 13(43.33 %) of the 30 samples had moderate dyspepsia, 9(30%) had severe dyspepsia, and 8(26.67%) had mild dyspepsia, whereas in the post-test, 14(46.67%) had moderate dyspepsia, 12(40%) had mild dyspepsia, and 4(13.33%) had severe dyspepsia. Ginger tea is effective when the pre-test and post-test values are compared. At the p<0.001 level, the calculated paired ‘t’ test value of t = 9.104 was found to be statistically highly significant. Demographic variables such as marital status and clinical variables such as dyspepsia duration and smoking history show a significant association with post-test dyspepsia level at p<0.05. Conclusion: According to the study findings, the overall pre-test symptom score was mild to moderate. The post-test symptom score of dyspepsia patients who were given ginger tea showed a significant reduction in symptom severity. It was concluded that ginger had a greater impact on symptom relief in dyspepsia patients than other foods.

A study to assess the effectiveness of ginger tea on symptoms of dyspepsia among adults

Introduction: Dyspepsia is a common gastrointestinal (GI) condition around the world. Dyspepsia is a symptom complex that includes a variety of upper GI symptoms such as epigastric pain or burning, early satiety, and post-prandial fullness. Treatment with complementary and alternative medicines, particularly herbal remedies, is one option for treating dyspepsia symptoms. Objectives: The objectives of the study were to evaluate the effectiveness of ginger tea on symptoms of dyspepsia among adults Methods: A one-group pre-test and post-test research design with 30 samples who met the inclusion criteria was used. Demographic and clinical data were collected using a self-structured questionnaire.During the pre-test, a questionnaire (LDQ) was used to assess the severity of dyspepsia symptoms using an interview method. Following the pre-test, 100ml of freshly prepared ginger tea was given once a day, seven days a week, in the morning before meals. The same tool was used for the post-test after seven days of ginger tea administration. Data has been subjected to descriptive and inferential statistics Result: During the pre-test, 13(43.33 %) of the 30 samples had moderate dyspepsia, 9(30%) had severe dyspepsia, and 8 (26.67 %) had mild dyspepsia, whereas in the post-test, 14(46.67%) had moderate dyspepsia, 12(40%) had mild dyspepsia, and 4(13.33%) had severe dyspepsia. Ginger tea is effective when the pre-test and post-test values are compared. At the p<0.001 level, the calculated paired ‘t’ test value of t = 9.104 was found to be statistically highly significant. Demographic variables such as marital status and clinical variables such as dyspepsia duration and smoking history show a significant association with post-test dyspepsia level at p<0.05. Conclusion: According to the study findings, the overall pre-test symptom score was mild to moderate. The post-test symptom score of dyspepsia patients who were given ginger tea showed a significant reduction in symptom severity. It was concluded that ginger had a greater impact on symptom relief in dyspepsia patients than other foods.

Do prokinetic agents provide symptom relief through acceleration of gastric emptying? An update and revision ofthe existing evidence.

Gastroparesis and functional dyspepsia are disorders characterized by upper gastrointestinal symptoms and multifaceted etiologies. One of the main therapeutic approaches is accelerating gastric emptying (GE) by means of prokinetic agents. Their efficacy has been demonstrated, although the association between symptom improvement and acceleration of emptying is less clear. Meta-analyses have found contradictory results. Differences in applied methodology and included trials might drive these contradictions. To provide a transparent meta-analysis update to elucidate the association between symptom improvement and acceleration of GE due to gastroprokinetic agents available for long-term use in patients with gastroparesis. Two approaches from earlier meta-analyses were executed and compared. One analyzed the relative changes on active treatment versus baseline, the other compared the change from baseline on active treatment versus the change from baseline on placebo. Papers that reported sufficient numerical data for both analyses were selected. Both analyses included the same trials. Overall, both approaches yield the same positive direction of association between symptom improvement and acceleration of emptying (0.291 (-0.391, 0.972), p=0.4 and 0.453 (0.123, 0.782), p=0.007 for the active-only and placebo-controlled analysis respectively). The association between symptom improvement and GE acceleration for studies using optimal GE tests was either 0.028 (p>0.9) or 0.463 (p=0.007), and for sub-optimal GE tests was either 0.370 (p=0.4) or 0.052 (p>0.9) depending on the used meta-analysis methodology. The applied methodology for GE testing, and the meta-analysis substantially impacts the conclusion. When considering the clinically relevant outcome of improvement from baseline, symptoms and emptying improve with prokinetics, but no correlation is found between both aspects. When the change over placebo is considered, limiting the analysis to scientifically more rigorous study approaches, changes in emptying rate and symptom improvement are positively associated.

Prevalence of delayed gastric emptying in patients with gastroparesis-like symptoms.

The European consensus defined gastroparesis as a condition characterised by delayed gastric emptying (GE) in the absence of mechanical obstruction, with a symptom pattern of predominant nausea and/or vomiting and overlapping postprandial distress syndrome (PDS). The distinction between patients with gastroparesis and those with functional dyspepsia (FD), another gastrointestinal condition characterised by predominant PDS or epigastric pain syndrome symptoms, is ongoing. To investigate the extent that symptom patterns may differentiate gastroparesis from FD. This retrospective study included 637 patients from Leuven University Hospital in 2006-2021 who had upper gastrointestinal symptoms, underwent a GE test, and completed the Dyspepsia Symptom Severity (DSS) questionnaire. Patients were identified as with gastroparesis-like symptoms (GPLS; i.e., moderate to severe nausea with moderate to severe PDS) or FD symptoms (not fitting GPLS). We excluded patients aged <18 years, and those with diabetes, organic gastrointestinal disease or a history of abdominal surgeries. Demographic and clinical variables were compared. Among 545 patients, 238 reported GPLS and 307 reported FD symptoms. Those with GPLS had a significantly higher prevalence of delayed GE (half emptying time (T1/2) ≥109 min) and lower body mass index than those with FD (33.2% vs 17.6%, p< 0.01; 19.9 vs 21.2, p< 0.01, respectively). Among GPLS patients, those with delayed GE had higher DSS than those without (13.0 vs 12.0, p< 0.01). In tertiary care patients who reported gastroparesis or FD symptoms, the presence of delayed GE was associated with GPLS. In patients with GPLS, delayed GE was associated with higher symptom severity.

The Association of Smoking and Coffee Consumption With Occurrence of Upper Gastrointestinal Symptoms in Patients With Active Helicobacter pylori Infection in Jazan City: A Cross-Sectional Study.

Helicobacter pylori(H. pylori) is a severe infection responsible for upper gastrointestinal symptoms (UGISs). Several causes of H. pylori infection include food ingestion and person-to-person transmission. Many lifestyle variables can affect the occurrence of UGISssuch ascoffee consumptionand smoking. To assess the association between smoking and coffee consumption and the occurrence of UGISs in patients with active H. pylori infection in Jazan city in Saudi Arabia. A descriptive cross-sectional research design was used to conduct the study between July 2022 and August 2022 in Jazan, southern Saudi Arabia. Male and female Saudis or non-Saudis ≥ 18 years of age with an active H. pylori infection were included. Participants under 18 years or without active H. pylori infection were excluded. Data were collected from participants using the convenience sampling technique and a structured questionnaire. The first part of the questionnaire evaluated social and demographic factors such as age, sex, place of residence, nationality, and educational level; the second part evaluated smoking and coffee-drinking habits. Furthermore, frequencies and percentages represented categorical variables. A continuous variable was converted to a categorical variable. The relationship between different variables is tested using the Chi-square test. The total number of respondents who completed the questionnaire was 1225, with only 422 having H. pylori entries in this study. There were 290 (68.7%) men and only 132 (31.3%) women among them; the majority were young adults (18-20 years old). More than half of the participants (53%) never smoked, 23% were active smokers, and 23% were former smokers. Around 27.1% smoke five cigarettes a day and 12.6% smoke five to 15 cigarettes a day. Three-hundred(71.1%) of the participants drank coffee. 23.9% indicated that they did not drink coffee. Of those who take coffee, more than half (51.7%) take fewer than three cups daily and 25.6% take approximately three to five cups of coffee per day. Our findings indicate a link between coffee consumption and UGISs (p = 0.00), while smoking did not have a significant relationship with UGISs (p = 0.06). Our research showed that drinking coffee was related to UGISs, but smoking was not found in people with active H. pylori infection. In smokers, UGISs increased substantially, but not significantly. We need real-world research to identify the association between coffee consumption and UGISs. In addition, we need to educate people at risk for UGISs to reduce coffee, smoking, and other risk factors.

Helicobacter Pylori Infection Association with Anxiety in Patients with Upper Gastrointestinal Symptoms in Hadhramout

Helicobacter Pylori Infection Association with Anxiety in Patients with Upper Gastrointestinal Symptoms in Hadhramout

Gastroparesis and Functional Dyspepsia: Spectrum of Gastroduodenal Neuromuscular Disorders or Unique Entities?

Gastroparesis is defined by delayed gastric emptying in the absence of mechanical obstruction of the stomach. Patients experience symptoms of nausea, vomiting, abdominal pain, fullness, and early satiety. The recognition of the disorder has progressed due to availability of gastric emptying scintigraphy and advancements made in understanding its pathophysiology and treatment options. The clinical presentation and treatment of gastroparesis overlap with a more commonly recognized disorder of gut-brain interaction, functional dyspepsia. Recent studies have reenergized the discussion whether these two are separate entities or perhaps reflect a spectrum of gastroduodenal neuromuscular disorders. The societal guidelines conflict on the utility of gastric emptying scintigraphy in assessment of patients with upper gastrointestinal symptoms. A better appraisal of similarities and differences between gastroparesis and functional dyspepsia will allow targeted treatment for these disorders. This is particularly important as specific pharmacological and endoscopic treatment options are being developed for gastroparesis which are unlikely to be helpful for functional dyspepsia. This review makes the case for considering these disorders in a spectrum where identification of both would most ideally position us toward providing the optimal clinical care.

Helicobacter pylori and eradication response in Jordanian children; A cross-sectional longitudinal observational study

Objective: To investigate the modalities of H. pylori diagnosis and management in Jordan and to elaborate on the feasibility of following international guidelines in diagnosing and managing H. pylori in children in our region. Methodology: This is a case series of children with upper gastrointestinal symptoms. Gastric and duodenal biopsies were collected when pre-endoscopic or intra-endoscopic findings suggested H-Pylori gastric infection. Results: The study included 116 children and adolescents, 52 (45%) were male and 64 (55.2%) females. Factors associated with failure of first eradication therapy; abdominal pain as a presenting symptom was significantly associated with the need for a second course of eradication. (p=0.037). Also, weight loss was significantly associated with the need for a second eradication therapy (p=0.028). Conclusion: Presenting symptoms and consequences of H pylori acquisition can be a serious pathological issue. Therefore, diagnostics and treatment of the infection, as well as proper documentation of the eradication success, can be beneficial.

Correlation analysis of gastric mucosal lesions with Helicobacter pylori infection and its virulence genotype in Guiyang, Guizhou province, China.

Helicobacter Pylori (H. pylori) infection is the most important factor affecting clinical outcome in patients with gastric mucosal lesions. This study aimed to investigate H. pylori infection in patients with gastric mucosal lesions and their virulence genotype in Guiyang, China. Pathological examinations of 1,364 biopsies from patients with upper gastrointestinal symptoms and H. pylori infection were analyzed according to different pathological types. The bacterial genome DNA was extracted from H. pylori strains isolated from gastric biopsies, and the cagA, vacA, and iceA virulence genes were detected and typed to analyze the correlation of their genotypes between different pathological lesions. The positive rate of H. pylori infection was approximately 19.9% (272/1,364), as determined by histopathological examination (HPE). It was more frequently detected in men than in women. A total of 85 H. pylori isolates were obtained from 280 clinical samples (positive rate 30.4%, 85/280). Of these 85 strains, cagA, vacA, and iceA genes were identified in 85.9%, 100%, and 83.5% of samples, respectively. Approximately 74.1% of strains were cagA East Asian type (cagA-ABD), and 11.8% of were cagA Western strains (cagA-AB, cagA-ABC), only present in patients with chronic non-atrophic gastritis. Gastric intraepithelial neoplasia and gastric cancer harbored both Asian strains. A total of 7 combinations of vacA genotypes were noted, among which s1c/m1b (30.6%) and s1c/m2 (41.2%) were the dominant genotypes. The predominant iceA genotype was iceA1 (64.7%). We observed that the positive rate of H. pylori infection was related to the pathological type of patients' gastric mucosal lesions. Isolated H. pylori strains showed a unique genotype, mainly East Asian type cagA (ABD), vacA s1c/m2 genotype, and iceA1. These results provide an important reference for further studies of H. pylori in Guizhou province, China.

Incidence of hiatus hernia among semi-urban population with upper gastrointestinal symptoms: a single cantered study

Background: Hiatal hernias are a common occurrence in the western population, with an estimated prevalence of 15% to 20%. These hernias may become symptomatic and lead to gastroesophageal reflux disease (GERD), dysphagia, dyspnoea, and may affect cardiac and respiratory function. Being overweight and elderly are the key risk factors in its development.Other known risk factors include: multiple pregnancies, history of oesophageal surgery, partial or full gastrectomy and certain disorders of the skeletal system associated with bone decalcification and degeneration.Methods: This is a retrospective study done on patients who presented to the surgical outpatient at Trichy SRM Medical College Hospital and Research Centre during the period July 2021 to July 2022.Results: Total of 97 (19.02%) patients presented with lax hiatus 41 (42.27%) and had it exclusively while 5 (5.16%), 31 (31.96%), 10 (10.31%) and 10 (10.31%) had it associated with antral gastritis, diffuse gastritis, pan gastritis and oesophagitis respectively. These values were statistically significant with a p value &lt;0.001. And lax hiatus was more commonly seen among female 56 (57.73%) compared to male 41 (42.27%) and hiatus hernia observed more in male 21 (58.33%) than female 15 (41.67%), there was no statistical significance observed among both the gender.Conclusions: Among the patients those who have presented to the surgery outpatient at Trichy SRM with upper gastrointestinal symptoms and in whom upper GI endoscopy were done the incidence of hiatus hernia was observed to be more prevalent among men compared to women in whom lax hiatus were seen to exist.

Ten controversies in gastroparesis and a look to the future.

Gastroparesis is a complex, challenging gastrointestinal disorder presenting with upper gastrointestinal symptoms, especially nausea and vomiting, with significant impact on patients' quality of life. After ruling out mechanical obstruction, it is essential to identify delay in gastric emptying for definitive diagnosis. The most common causes are idiopathic (no identified etiology), diabetes mellitus, and postsurgical status. Management of gastroparesis focuses on dietary modifications and treatment directed to symptom relief. Unfortunately, approximately one-third of patients are refractory to pharmacological therapy, and the effectiveness of the few nonpharmacological options has been questioned. Extensive review of the literature identifies several uncertainties or controversies regarding the differential diagnosis based on the spectrum of symptoms, the lack of availability of reliable diagnostic test, and questions regarding effective therapeutic options. In this review, we discuss ten controversies regarding gastroparesis: clinical presentation, diagnosis, overlap syndromes, pathophysiology, etiology, as well as pharmacological and nonpharmacological therapeutic options. In addition, we briefly review studies exploring pathological, inflammatory, and molecular disturbances affecting the intrinsic neuromuscular elements that may be involved in the pathophysiology of gastroparesis and may constitute possible therapeutic targets in the future. Finally, we tabulate future research opportunities to resolve these controversies in the management of patients with gastroparesis.

Prevalence Difference of Helicobacter pylori Infection Between Tibetan and Han Ethnics in China: A Meta-analysis on Epidemiologic Studies (SIGES).

China is a multi-ethnic country, and the prevalence of Helicobacter pylori (H. pylori) infection may be diverse among ethnics. This meta-analysis was conducted to compare the prevalence of H. pylori infection between Tibetans and Han ethnics. Ten studies that reported the prevalence of H. pylori infection between Tibetans and Hans in China were eligible. The pooled prevalence of H. pylori infection was 62.2% versus 55.3% among Tibetans and Hans, respectively. Tibetans had a higher risk of H. pylori infection than Hans (odds ratio [OR] = 1.38). In subgroup analysis, Tibetans with upper gastrointestinal symptoms (OR = 1.51), inhabiting in Tibet (OR = 1.51), or inhabiting in Northwestern region (OR = 1.15) had significantly higher risks of H. pylori infection. In addition, in the recent 10 years, Hans showed a decreased risk of H. pylori infection (OR = 1.81). Heterogeneity was common, while sensitivity analyses showed partially inconsistent results against main findings. This study demonstrated higher prevalence of H. pylori infection in Tibetans compared with Hans, especially in recent years, or in Tibet and northwest China, as well as symptomatic Tibetans. The results suggest tailored strategy and robustness need to be further considered for H. pylori screening and eradication among Tibetans.

Diagnostic utility of endoscopic duodenal biopsies and histopathological finding in upper gastrointestinal diseases: A 2-year analysis

Background: Diseases of gastrointestinal (GI) tract present wit myriad signs and symptoms. Appropriate management of these diseases involves proper evaluation. Upper GI endoscopies are becoming increasingly popular because it helps in first localizing the lesion and then biopsy specimens can be obtained from affected area. Duodenal biopsy followed by histopathological examination may clinch the diagnosis in majority of the cases. Aims and Objectives: The aim of the study was to find out diagnostic utility of endoscopic duodenal biopsies and histopathological finding in the upper GI diseases. (1) To analyze duodenal endoscopic biopsy samples obtained from patients presenting with the upper GI symptoms. (2) To correlate endoscopic and histopathological findings in studied cases. Materials and Methods: A retrospective and prospective observational study was carried out at the private histopathology center over a period of 2 years. All the patients underwent upper GI endoscopy with duodenal biopsies using flexible endoscope. Histopathology of the samples obtained from endoscopic duodenal biopsies in patients presenting with the upper GI symptoms were analyzed. The endoscopic findings such as mass lesion or ulcerative lesion were correlated with histopathological findings. Results: Out of these 704 biopsies, 303 (43.04%) were esophageal biopsies, 220 [31.25%] were gastric, and 181 [25.71%] were duodenal biopsies. There were 129 (71.27%) males and 52 (28.73%) females with a M: F ratio of 2.5: 1. The mean age of the cases was found to be 54.7±12.32 years. Out of 181 biopsies which were performed in this study, 100 (55.25%) lesions were found to be having neoplastic etiology whereas 81 (44.75%) lesions were found to have non-neoplastic etiology. Among patients who were found to have duodenal growth on endoscopy well differentiated adenocarcinoma (15.47%) followed by moderately differentiated adenocarcinoma (6.63%) were the common pathologies. In cases of non-neoplastic etiology, non-specific duodenitis was most common pathology (17.13%). Conclusion: Endoscopic biopsy followed by histopathological examination is cornerstone of the management of patients presenting with intractable upper GI symptomatology.

Underlying cancer risk among patients with fatigue and other vague symptoms: a population-based cohort study in primary care.

Presenting to primary care with fatigue is associated with slightly increased cancer risk, although it is unknown how this varies in the presence of other 'vague' symptoms. To quantify cancer risk in patients with fatigue who present with other 'vague' symptoms in the absence of 'alarm' symptoms for cancer. Cohort study of patients presenting in UK primary care with new-onset fatigue during 2007-2015, using Clinical Practice Research Datalink data linked to national cancer registration data. Patients presenting with fatigue without co-occurring alarm symptoms or anaemia were identified, who were further characterised as having co-occurrence of 19 other 'vague' potential cancer symptoms. Sex- and age-specific 9-month cancer risk for each fatigue-vague symptom cohort were calculated. Of 285 382 patients presenting with new-onset fatigue, 84% (n = 239 846) did not have co-occurring alarm symptoms or anaemia. Of these, 38% (n = 90 828) presented with ≥1 of 19 vague symptoms for cancer. Cancer risk exceeded 3% in older males with fatigue combined with any of the vague symptoms studied. The age at which risk exceeded 3% was 59 years for fatigue-weight loss, 65 years for fatigue-abdominal pain, 67 years for fatigue-constipation, and 67 years for fatigue-other upper gastrointestinal symptoms. For females, risk exceeded 3% only in older patients with fatigue-weight loss (from 65 years), fatigue-abdominal pain (from 79 years), or fatigue-abdominal bloating (from 80 years). In the absence of alarm symptoms or anaemia, fatigue combined with specific vague presenting symptoms, alongside patient age and sex, can guide clinical decisions about referral for suspected cancer.

Perioperative Management of Pediatric Crohn's Disease.

Crohn's disease (CD) is a chronic inflammatory condition that may affect any part of the gastrointestinal tract. It is transmural in nature and complications such as fistula, strictures and peri-anal disease may occur. There is more extensive anatomic involvement (50% ileocolonic, 20% colonic, 30% with upper GI symptoms) and a higher surgical risk in pediatrics than adults (50% vs 14% by age 30). Studies have shown 3.4%-7.9% of patients require surgery in first year after diagnosis, 13.8-47.2% by 5 years and 28%-35% by 10 years (1). There are three major surgical categories: ileocecal resection, treatment of complication, (fistula/stricture-figure 1,2) or salvage procedure for severe refractory disease. In addition, surgery may be considered with active short segment disease or children illustrating poor growth despite optimized medical therapy (ESPGHAN). Unfortunately, much data on pediatrics is derived from single centers rather than population-based cohorts and the most recent societal reports were based on studies with minimal biologic use (18-24%) (1). Despite larger use of biologics, resection is still needed in 20%- 34%, thus effective peri-operative management of pediatric CD is imperative (1).

Causal effect of anxiety and depression status on the symptoms of gastroesophageal reflux disease and functional dyspepsia during proton pump inhibitor therapy.

Although anxiety and depression status is considered related to gastroesophageal reflux disease (GERD) and functional dyspepsia (FD) symptoms, ambiguity primarily arises from the difficulty in determining their cause-effect relationships. We aimed to examine the longitudinal reciprocal causation between anxiety/depression status and GERD/FD symptoms among symptomatic adult patients with GERD. Adult (≥ 20years) patients with GERD symptoms received PPI treatment for 4weeks after endoscopy. GERD and FD symptom subscales (GERD-SS/FD-SS) were evaluated using the gastroesophageal reflux and dyspepsia therapeutic efficacy and satisfaction test (GERD-TEST). Anxiety and depression status were evaluated using the hospital anxiety and depression scale (HADS). A cross-lagged analysis using structural equation modeling was conducted to examine causal relationships among psychiatric bias (anxiety and depression scores) and upper gastrointestinal symptoms (GERD-SS and FD-SS scores) over time. A total of 182 patients with GERD (men: 120; age: 57.1 ± 12.8years; body mass index: 24.2 ± 4.1kg/m2; nonerosive reflux disease/erosive reflux disease: 61/121) were eligible before (T1) and after 4weeks (T2) of PPI therapy. The cross-lagged effect model indicated that anxiety at T1 contributed to the FD-SS at T2 (β = 0.18*) and depression at T1 contributed to the GERD-SS at T2 (β = 0.23*) (*p < 0.05). Psychiatric bias was a risk factor for refractory GERD and FD. Anxiety and depression status reduced the therapeutic effect of PPIs on GERD and FD symptoms. Therefore, attention is required to detect the anxiety/depression status of patients with GERD/FD symptoms to treat patients appropriately and optimize therapeutic outcomes.

S582 Gastroparesis Is Associated With More Concurrent Gastrointestinal Symptoms and Motility Disorders Than Functional Dyspepsia

Introduction: Gastroparesis (GP) and functional dyspepsia (FD) present with overlapping upper gastrointestinal (GI) symptoms, such as: nausea, vomiting, early satiety, postprandial fullness, epigastric pain, and bloating. Other gastrointestinal motility disorders may be concurrent in patients with GP. The goal of study was to compare the presence of GI symptoms and other motility disorders in patients with GP and FD. Methods: A retrospective cohort study was performed on IBM Explorys (1999-2022), which contains de-identified healthcare information from more than 64 million patients across the United States. Adult patients who have completed gastric emptying study were selected, and subsequently divided into GP and FD cohorts. GP cohort consists of patients with a diagnosis of gastroparesis, with exclusion criteria: cyclical vomiting syndrome, psychoactive substance abuse, eating disorder, factitious disorder, malignant tumor of esophagus and stomach, neoplasm of abdomen, gastric or intestinal obstruction, IBD, adhesion of intestine, carcinomatosis, perforation of intestine, Roux-en-Y gastrojejunostomy, and gastrectomy. FD cohort was similarly constructed with additional exclusion criteria: gastroparesis, gastrointestinal ulcer, brain neoplasm and pancreatitis. The presence of GERD, IBS, GI symptoms and common GI medications were collected. Odds ratios (ORs) with 95% confidence interval were used to compare the cohorts. Results: GP and FD cohort consisted of 17,570 and 60,230 patients respectively (Table). There was a higher prevalence of concurrent motility disorders in patients with GP than FD, including GERD and IBS (65.1 vs 50.9%, 18.6 vs 13.3%). Patients with GP tend to present with more upper and lower GI symptoms than FD, including nausea (65.1 vs 46.3%), vomiting (53.0 vs 33.3%), epigastric pain (36.9 vs 27.2%), heartburn (8.6 vs 7.5%), diarrhea (34.6 vs 23.3%) and constipation (37.2 vs 21.8%) (P< 0.0001) (Figure). However, there was no difference in terms of early satiety and bloating when comparing the two groups. Acid reducing medications, anti-nausea medications and prokinetic agents were more commonly prescribed for patients with GP than FD, including proton pump inhibitors (PPIs), H2 receptor antagonists (H2RA), Metoclopramides and Ondansetron (p< 0.0001). Conclusion: GP is associated with more concurrent GI symptoms and motility disorders compared with FD. Acid reducing medications, anti-nausea and prokinetic medications are more commonly prescribed for patients with GP.Figure 1.: Comparison of GI symptoms between gastroparesis and functional dyspepsia Table 1. - Comparison of GI motility disorders, symptoms and medications between gastroparesis and functional dyspepsia GP (N=17570) % FD (N=60230) % OR P GI diseases GERD 11430 65.1% 30650 50.9% 1.74-1.86 < 0.0001 IBS 3260 18.6% 8030 13.3% 1.42-1.55 < 0.0001 Symptoms Upper GI symptoms Nausea 11430 65.1% 27910 46.3% 2.08-2.23 < 0.0001 Vomiting 9310 53.0% 20060 33.3% 2.18-2.34 < 0.0001 Early satiety 1660 9.5% 5780 9.6% 0.93-1.04 0.5556 Epigastric pain 6490 36.9% 16380 27.2% 1.51-1.62 < 0.0001 Heartburn 1510 8.6% 4500 7.5% 1.10-1.24 < 0.0001 Lower GI symptoms Diarrhea 6070 34.6% 14050 23.3% 1.67-1.80 < 0.0001 Constipation 6540 37.2% 13110 21.8% 2.06-2.21 < 0.0001 Bloating 60 0.3% 170 0.3% 0.90-1.63 0.2039 Medications PPI 13680 77.9% 35430 58.8% 2.37-2.56 < 0.0001 H2RA 7710 43.9% 18310 30.4% 1.73-1.85 < 0.0001 Metoclopramide 8630 49.1% 12490 20.7% 3.56-3.82 < 0.0001 Ondansetron 12570 71.5% 31330 52.0% 2.24-2.41 < 0.0001

S508 Upper Gastrointestinal Manifestations of SARS-CoV-2 Infection in the United States: A Population-Based Study

Introduction: Extrapulmonary manifestations of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Infection are frequently reported and correlate with disease severity and mortality. Our study aimed to assess the association between upper gastrointestinal (GI) disorders and upper GI symptoms with COVID-19 infection. Methods: We queried a large multi-center database (Explorys Inc., Cleveland, OH, USA), an aggregate of electronic health records of 26 different healthcare systems with 360 hospitals. In the last two years, we identified patients with a Systemized Nomenclature of Medicine-Clinical Terms (SNOMED-CT) diagnosis of “COVID-19”. We compared Demographic data and clinical characteristics of patients with and without a diagnosis of COVID-19. Results: Among the 70,039,864 individuals included in this database, 34,720 individuals were diagnosed with a COVID-19 infection, a prevalence rate of 493 per 100,000 in the US population. COVID-19 infection was more commonly associated with patients of age >65 years (OR 1.18, p < 0.0001) and in African American (OR 2.90, p < 0.0001). There was no statistically significant gender-based differences. COVID-19 patients were more likely to be suffer from upper GI disorders such as gastritis (OR 4.38), gastroesophageal reflux disease (GERD) (OR 6.02), esophagitis (OR 3.84), upper GI bleeding (OR 4.91), and duodenitis (OR 4.95), p < 0.0001 to all. COVID-19 patients were also found to be more likely to have upper GI symptoms such as nausea and vomiting (OR 4.12), abdominal pain (OR 3.70), loss of appetite (OR 3.27), weight loss (OR 2.98), and dysphagia (OR 11.84), p< 0.0001 to all (Figure). Conclusion: In this large population-based study, we found an increased association of upper GI symptoms and upper GI disorders with a diagnosis of COVID-19 infection. It is unclear if patients with a concomitant upper GI etiology have a prolonged or more severe clinical course or prolonged virus shedding in GI specimens. Further prospective studies are required to evaluate this association. (Table)Figure 1.: A comparison of the prevalence of upper gastrointestinal symptoms and conditions in patients with and without COVID-19 infection. Table 1. - A comparison of the baseline characteristics and upper gastrointestinal conditions and symptoms of patients with and without COVID-19 infection COVID-19 patients (n, %) Non-COVID-19 patients (n, %) OR CI p-value Demographics Age: 18-65 23,030 (66%) 47,926,050 (68%) 0.92 0.90 to 0.94 < 0.0001 Age: >65 11,730 (34%) 21,254,620 (30%) 1.18 1.15 to 1.21 < 0.0001 Male 15,620 (45%) 31,412,530 (45%) 1.01 0.99 to 1.04 0.1954 Female 19,060 (55%) 38,452,220 (55%) 1.01 0.99 to 1.03 0.3521 Caucasian 16,680 (48%) 37,840,470 (54%) 0.79 0.78 to 0.81 < 0.0001 African American 8,440 (24%) 7,023,300 (10%) 2.9 2.83 to 2.97 < 0.0001 Upper GI Conditions and Symptoms Gastritis 800 (2%) 376,990 (0.5%) 4.38 4.08-4.70 < 0.0001 GERD 3,140 (9%) 1,142,660 (1.6%) 6.02 5.81-6.25 < 0.0001 Esophagitis 250 (0.7%) 132,790 (0.2%) 3.84 3.39-.35 < 0.0001 Duodenitis 110 (0.3%) 45,130 (0.01%) 4.95 4.11-5.97 < 0.0001 Upper GI bleed 160 (0.5%) 66,230 (0.1%) 4.91 4.21-.74 < 0.0001 Nausea and vomiting 740 (3%) 370,390 (0.5%) 4.12 3.83-4.43 < 0.0001 Abdominal pain 2,240 (7%) 1,286,290 (1.8%) 3.70 3.55-3.87 < 0.0001 Loss appetite 230 (0.7%) 143,250 (0.2%) 3.27 2.87-3.72 < 0.0001 Weight loss 350 (1%) 239,400 (0.3%) 2.98 2.69-3.31 < 0.0001 Dysphagia 760 (2%) 132,790 (0.2%) 11.84 11.01-12.72 < 0.0001 Univariate analysis used to calculate OR. OR; odd ratio. CI; confidence interval.

S1548 GI Dysmotility Symptoms Are Not Associated With Increased L-Dopa Requirements in Parkinson’s Disease Patients

Introduction: Gastrointestinal (GI) motility disorders like gastroparesis or small bowel bacterial overgrowth are thought to impair efficacy of L-dopa, which is absorbed in the proximal small intestine, resulting in motor fluctuations among Parkinson’s Disease (PD) patients that prompt dosage increases. While symptoms of dysmotility are frequently reported in PD, results are mixed concerning their effect, if any, on L-dopa pharmacokinetics. In this study, we compare L-dopa equivalent daily dose (LEDD) and motor function among patient with 5 upper GI symptoms to study the possible relationship between dysmotility symptoms and increased L-dopa requirement. Methods: Two hundred PD patients evaluated by outpatient neurology at Mass General Brigham Healthcare between 2018-2019 were included. History of 5 upper GI symptoms (dysphagia, nausea, vomiting, epigastric pain, and bloating), as well as LEDD were obtained from the medical record. Unified PD Rating Scale (UDPRS) part III motor exam scores off medication were extracted from clinical notes. Differences between LEDD and UDPRS motor scores among patients with and without a history of each of the 5 GI symptoms were calculated via Student t-tests. Results: Dysphagia was significantly associated with increased LEDD (230mg, P=0.0067) as well as increased motor severity (4.6 UDPRS, P=0.036). In contrast, nausea was associated with decreased LEDD (-187 mg, P=0.030) despite similar motor severity (1.1 UDPRS, P=0.63) to those without nausea (Table). There were no differences in LEDD and UDPRS scores among patients with and without vomiting, epigastric pain, and bloating. Conclusion: Except dysphagia, we found that GI dysmotility symptoms were not associated with increased LEDD nor increased motor severity. This suggests that symptomatic GI dysmotility may not be directly related to poor L-dopa absorption, a common clinical question for PD patients referred to GI. While dysphagia was linked with higher LEDD, this may have stemmed from higher UDPRS scores in this population. Interestingly, those with nausea required lower LEDD despite comparable motor severity. Nausea, a frequent symptom of delayed intestinal transit, may extend absorption time leading to better motor outcomes on less L-dopa. However, further studies are needed to discern any underlying mechanism. Our results nonetheless indicate that clinical management of dysmotility may not reduce motor fluctuations and the need for increased L-dopa as previously presumed. Table 1. - Changes in L-dopa Requirements and Motor Severity in the Presence of Dysmotility Symptoms GI Symptom ΔLEDD, mg (SD) P value ΔUDPRS III (SD) P value Nausea -187 (86) 0.03 1 (2) 0.633 Vomiting 11 (95) 0.91 -2 (2) 0.343 Dysphagia 230 (84) 0.007 5 (2) 0.036 Epigastric pain 101 (104) 0.33 0 (3) 0.881 Bloating 62 (99) 0.533 1 (2) 0.764 LEDD—L-dopa equivalent daily dose UDPRS—Unified Parkinson's Disease Rating Scale.

S2520 Severe Nausea and Hyperemesis Are Not Always Gastrointestinal: Non-GI Immune-Related Adverse Events Presenting as Upper GI Symptoms

S2520 Severe Nausea and Hyperemesis Are Not Always Gastrointestinal: Non-GI Immune-Related Adverse Events Presenting as Upper GI Symptoms