A recent study found that less than a third of gastroparesis patients had significant symptom relief after treatment, and identified a number of independent predictors of symptom reduction.
“Little is known about the longitudinal course of patients with gastroparesis and the clinical or pathophysiological characteristics, if any, that may predict it,” Pankaj J. Pasricha, MD, from the Johns Hopkins University School of Medicine and department of epidemiology, and colleagues wrote. “In this study, our aim was to describe changes in patient clinical outcomes and determine what baseline attributes, if any, predict substantial improvement in symptoms using follow-up data available at 48 weeks from patients followed up prospectively for up to 4 years (median, 2.1 years). A secondary aim was to describe the proportion of symptomatic improvement in these patients over the study follow-up period.”
Pankaj J. Pasricha
They evaluated 262 adults (82% women; 89% white; mean age, 44 years, SD 13.5 years) enrolled in the Gastroparesis Registry who were diagnosed with either idiopathic (68%) or diabetic gastroparesis, had symptoms lasting at least 12 weeks and no endoscopic evidence of mechanical gastric obstruction. Patients were seen every 16 weeks and received standard care at seven tertiary centers.
Overall, 28% of patients’ Gastroparesis Cardinal Symptom Index Scores — a validated 5-point symptom severity scale — decreased by at least one point at 48 weeks, but there were no significant reductions after that. There were no significant differences in outcomes between diabetic or idiopathic gastroparesis patients.
Factors independently associated with week 48 symptom relief included:
- male sex (OR = 2.3; 95% CI, 0.93-5.67);
- older age (≥ 50 years; OR = 3.35; 95% CI, 1.62-6.91);
- initial infectious prodrome (OR = 2.22; 95% CI, 1.01-4.87);
- use of antidepressants (OR = 2.27; 95% CI, 1.13-4.58); and
- 4-hour gastric retention > 20% (OR = 2.22; 95% CI, 1.12-4.4).
Factors associated with no symptom relief included:
- being overweight or obese (BMI ≥ 25 kg/m2; OR = 0.43; 95% CI, 0.22-0.84);
- history of smoking (OR = 0.46; 95% CI, 0.22-0.98);
- use of pain modulators (OR = 0.34; 95% CI, 0.14-0.81);
- moderate-to-severe abdominal pain (OR = 0.4; 95% CI, 0.17-0.96);
- severe GERD symptoms (OR = 0.66; 95% CI, 0.5-0.89); and
- moderate-to-severe depression (OR = 0.45; 95% CI, 0.22-0.93).
“These results may help us triage patients with gastroparesis (at least for those refractory patients presenting to tertiary medical centers) for more focused or aggressive treatment strategies,” the researchers concluded. “We also hope that these results will provide the basis for validation studies in the larger community setting in the future.”
“This report raises a number of issues and questions for practicing clinicians,” Jan Tack Targid, MD, from University of Leuven and University Hospital Gasthuisberg, Belgium, and Arnold Wald, MD, from University of Wisconsin School of Medicine and Public Health, wrote in a related editorial. “Should they order a gastric emptying test in patients presenting with symptoms of postprandial fullness, early satiety, nausea, vomiting and upper abdominal bloating, to identify those with ‘gastroparesis,’ and if so, should they conclude that their short-to medium-term prognosis is poor, based on this manuscript? Before they do so, some of the limitations of the consortium’s database should be considered,” including that it probably consists of primarily difficult-to-treat patients, and that there was no comparator group with similar symptoms, but normal gastric emptying.
“The need for further therapeutic studies is more pressing than ever, taking into account recent discouraging outcomes of studies with prokinetics, devices and antidepressants,” they concluded. – by Adam Leitenberger
Disclosures: The researchers report no relevant financial disclosures. Healio Gastroenterology could not confirm Targid’s and Wald’s relevant financial disclosures at the time of publication.