Q&A: Spreading awareness during gastroparesis awareness month
“Gastroparesis (GP) can be extremely debilitating and life threatening,” Ceciel T. Rooker, president of the International Foundation for GI Disorders (IFFGD) said in IFFGD’s 2021 media toolkit. “Many patients suffer without others knowing what they are battling internally every single day.”
Although the National Institute of Diabetes and Digestive and Kidney Diseases reported GP itself as uncommon, symptoms similar to those of GP occur in one out of every four adults in the U.S. They further reported patients with diabetes and those who underwent certain surgeries are at a greater risk for GP development.
In recognition of August as GP awareness month, Healio Gastroenterology spoke with Thomas Abell, MD, University of Louisville Jewish Hospital Outpatient Care Center, regarding the known facts about GP and what future research is needed to inform care in this condition.
Healio: What is GP and how many people does it effect?
Thomas Abell: Technically, GP refers to delayed emptying of the stomach with no obvious obstruction. Clinically, this is most often defined by a gastric emptying test (often a 4-hour radionuclide test after a solid meal). This delayed emptying is often, but not always, associated with upper GI symptoms such as nausea, vomiting, abdominal pain, early satiety and/or bloating. Lower GI symptoms are not uncommon in patients with GP.
How many people it effects has been the source of much discussion and sometimes controversy. Some epidemiologic studies have identified GP prevalence numbers in the range of 10 patients to 40 patients per 100,000 people, depending on factors such as sex and etiology of GP. Other studies have revealed incidence and prevalence numbers much greater than these.
In contrast, up to 9.5% of the U.S. population can have some of the symptoms of GP at some point, based on an internet survey in the last 5 years.
Healio: How debilitating might a misdiagnosis of GP be?
Abell: As with any illness, the more accurate the diagnosis, the better the chance for successful and appropriate treatment. Many patients with GP, or with the GP symptoms, have other upper gut disorders, such as heartburn.
Healio: What complications does GP carry?
Abell: Complications of GP can be divided into two areas: acute and chronic. Acutely, patients can suffer from fluid and electrolyte disorders, as well as exacerbations of underlying metabolic conditions, such as diabetes mellitus. Chronically, patients with GP can have a multitude of complications, including those related to malnutrition. In addition, patients can have complications related to therapies, including from drugs, devices, other procedures and surgeries.
Healio: What is the current best-practice treatment option/plan?
Abell: The best practices for GP are based on those that were summarized in the 2013 ACG Gastroparesis Guidelines. These are currently being revised and several changes are envisioned that can be described as evolutionary.
Healio: What should clinicians know about treating their patients with GP?
Abell: One of the more important things may be that patients with GP or GP symptoms can have several extra gastric manifestations, either as underlying conditions or more often as coexistent disorders.
Another aspect is that patients with GP uniformly report decreased quality of life, as well as difficulties accessing care. Also, some patients have frequent office visits, emergency room encounters and hospitalizations for both acute and chronic problems related to their GP.
Healio: What additional research is still needed on his condition?
Abell: There are several areas of research in GP that are being conducted by groups such as the NIH Gastroparesis Clinical Research Consortium, among other groups. One important area of research is to find the underlying disorder(s) behind GP and how these disorders related to pathophysiology. Another area is to better define the spectrum of disorders that may share common pathophysiology, from functional dyspepsia to GP-like syndrome with non-delayed gastric emptying, GP with delayed emptying and chronic or recurrent unexplained nauseas and vomiting. Lastly, there is a focus on defining what treatment(s) work best for GP and related syndromes.
International Foundation for GI Disorders. Gastroparesis awareness month. https://aboutgastroparesis.org/living-with-gastroparesis/gastroparesis-awareness-month/. Accessed August 10, 2021.
National Institute of Diabetes and Digestive and Kidney Diseases. Definition and facts for gastroparesis. https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/definition-facts. Accessed August 10, 2021.