Pankaj J Pasricha1, Katherine P Yates2, Linda Nguyen3, John Clarke2, Thomas L Abell4, Gianrico Farrugia5, William L Hasler6, Kenneth L Koch7, William J Snape8, Richard W McCallum9, Irene Sarosiek9, James Tonascia2, Laura A Miriel2, Linda Lee2, Frank Hamilton10, Henry P Parkman11. 1. Division of Gastroenterology, Johns Hopkins University School of Medicine, and Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. Electronic address: Ppasric1@jhmi.edu. 2. Division of Gastroenterology, Johns Hopkins University School of Medicine, and Department of Epidemiology, Johns Hopkins University, Baltimore, Maryland. 3. Division of Gastroenterology and Hepatology, Stanford University, Palo Alto, California. 4. Division of Gastroenterology, University of Louisville, Louisville, Kentucky. 5. Mayo Clinic, Rochester, Minnesota. 6. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. 7. Department of Internal Medicine/Gastroenterology, Wake Forest University, Winston-Salem, North Carolina. 8. Center of Neurogastroenterology and Motility, California Pacific Medical Center, San Francisco, California. 9. Internal Medicine Department, Texas Tech University, El Paso, Texas. 10. Digestive Diseases Branch, National Institute of Diabetes and Digestive and Kidney Diseases, Bethesda, Maryland. 11. Gastroenterology Section Department of Medicine, Temple University, Philadelphia, Pennsylvania.
Abstract
BACKGROUND & AIMS: Gastroparesis is a chronic clinical syndrome characterized by delayed gastric emptying. However, little is known about patient outcomes or factors associated with reduction of symptoms. METHODS: We studied adult patients with gastroparesis (of diabetic or idiopathic type) enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Gastroparesis Registry, seen every 16 weeks and treated according to the standard of care with prescribed medications or other therapies at 7 tertiary care centers. Characteristics associated with reduced symptoms, based on a decrease of 1 or more in the gastroparesis cardinal symptom index (GCSI) score after 48 weeks of care, were determined from logistic regression models. Data were collected from patients for up to 4 years (median, 2.1 y). RESULTS: Of 262 patients, 28% had reductions in GCSI scores of 1 or more at 48 weeks. However, there were no significant reductions in GCSI score from weeks 48 through 192. Factors independently associated with reduced symptoms at 48 weeks included male sex, age 50 years and older, initial infectious prodrome, antidepressant use, and 4-hour gastric retention greater than 20%. Factors associated with no reduction in symptoms included overweight or obesity, a history of smoking, use of pain modulators, moderate to severe abdominal pain, a severe gastroesophageal reflex, and moderate to severe depression. CONCLUSIONS: Over a median follow-up period of 2.1 years, 28% of patients treated for gastroparesis at centers of expertise had reductions in GCSI scores of 1 or greater, regardless of diabetes. These findings indicate the chronic nature of gastroparesis. We identified factors associated with reduced symptoms that might be used to guide treatment. ClinicalTrials.gov no: NCT00398801.
BACKGROUND & AIMS:Gastroparesis is a chronic clinical syndrome characterized by delayed gastric emptying. However, little is known about patient outcomes or factors associated with reduction of symptoms. METHODS: We studied adult patients with gastroparesis (of diabetic or idiopathic type) enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Gastroparesis Registry, seen every 16 weeks and treated according to the standard of care with prescribed medications or other therapies at 7 tertiary care centers. Characteristics associated with reduced symptoms, based on a decrease of 1 or more in the gastroparesis cardinal symptom index (GCSI) score after 48 weeks of care, were determined from logistic regression models. Data were collected from patients for up to 4 years (median, 2.1 y). RESULTS: Of 262 patients, 28% had reductions in GCSI scores of 1 or more at 48 weeks. However, there were no significant reductions in GCSI score from weeks 48 through 192. Factors independently associated with reduced symptoms at 48 weeks included male sex, age 50 years and older, initial infectious prodrome, antidepressant use, and 4-hour gastric retention greater than 20%. Factors associated with no reduction in symptoms included overweight or obesity, a history of smoking, use of pain modulators, moderate to severe abdominal pain, a severe gastroesophageal reflex, and moderate to severe depression. CONCLUSIONS: Over a median follow-up period of 2.1 years, 28% of patients treated for gastroparesis at centers of expertise had reductions in GCSI scores of 1 or greater, regardless of diabetes. These findings indicate the chronic nature of gastroparesis. We identified factors associated with reduced symptoms that might be used to guide treatment. ClinicalTrials.gov no: NCT00398801.
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