Clinical Features and Severity of Gastric Emptying Delay in Brazilian Patients With Gastroparesis

Abstract

-Context -Gastroparesis is defined by delayed gastric emptying without mechanical obstruction of the gastroduodenal junction, which has been increasingly investigated. Nevertheless, knowledge on the relationships between etiology, symptoms and degree of delayed gastric emptying is limited. Objectives -The demographic, clinical and etiological features of Brazilian patients with gastroparesis were studied and the relationships between these findings and the severity of gastric emptying were determined.Method -This is a retrospective study of medical records of 41 patients with symptoms suggestive of gastroparesis admitted between 1998 and 2011, who had evidence of abnormally delayed gastric emptying on abdominal scintigraphy. Cases with idiopathic gastroparesis were compared with those of patients with neurologic disorders or diabetes mellitus, in whom autonomic neuropathy is likely to occur. Results -The majority of the patients were women (75.6%) with a median age of 41 years and a long-term condition (median: 15 years). Twelve patients (29.3%) had a body mass index of less than 20 kg/m 2 . The most common presenting symptoms were dyspepsia (53.6%), nausea and vomiting (46.3%), weight loss (41.4%) and abdominal pain (24.3%). Regarding etiology, 16 patients had digestive disorders including idiopathic gastroparesis (n = 12), 12 had postoperative conditions, 11 had diseases of the nervous system, five had diabetes mellitus and in three cases gastroparesis was associated to a variety of conditions. In the majority of patients (65.8%) gastric emptying was severely delayed. There was no association between etiology of gastroparesis, type of presenting symptoms and the degree of delay in gastric emptying. Gastroparesis patients with proven (neurological conditions) or presumed (diabetes) nervous system involvements were significantly younger (P = 0.001), had more recent symptom onset (P = 0:03) and a trend towards more severe gastric empty (P = 0:06). There were no significant differences between this subgroup of patients and that comprising cases of idiopathic gastroparesis regarding any of the variables studied. Conclusions -The demographic, clinical and etiological characteristics of Brazilian patients with gastroparesis are quite varied, but there is a predominance of women with long-standing symptoms and marked delay in gastric emptying. The type of presenting symptoms and the degree of delay in gastric emptying do not predict the etiology of gastroparesis. However, severely delayed gastric emptying in younger patients with recent symptom onset should raise the suspicion of impaired neural control of gastro-duodenal motility. HEADINGS -Gastroparesis. Digestive signs and symptoms. Neuropathies. Diabetes mellitus.

Health‐care resource use and costs associated with diabetic and idiopathic gastroparesis: A claims analysis of the first 3 years following the diagnosis of gastroparesis

“…The burden of persistent gastroparesis symptoms 16,36‐38 and its negative impact on HRQoL and work productivity, 17 as described in prior studies, also indicate the suboptimal performance of current treatments. Multiple studies have reported clinically assessed prevalence of persistent gastroparesis symptoms, including nausea and vomiting (up to 58% of patients), 36 abdominal pain (up to 51%), 16,36,38 and diarrhea and constipation (around 17%) 37 . Other studies of self‐reported outcomes have confirmed the high symptom burden of gastroparesis, with 85–95% of patients reporting nausea and 25–45% reporting abdominal pain, 39‐42 and high rates of total parenteral nutrition (~20% in the prior year) or a feeding tube (19%), 17 and reduction in daily activities, school/work schedules, and annual income 17…”

“…Indeed, 60% of patients with gastroparesis in a 2017 survey expressed dissatisfaction with their therapy. 25 The burden of persistent gastroparesis symptoms 16,[36][37][38] and its negative impact on HRQoL and work productivity, 17 as described in prior studies, also indicate the suboptimal performance of current treatments.…”

Gastroparesia no idoso

“…Pacientes diabéticos apresentam um espectro de anormalidades da função motora gástrica, caracterizando a gastropatia diabética, sendo que a gastroparesia diabética, com estase gástrica expressiva, representa apenas a extremida-de deste espectro. Os casos de gastroparesia diabética representam em torno de 30% dos casos de gastroparesia [5][6][7] .…”

“…Também, possíveis lesões de vago podem ocorrer durante ablação por cateter no tratamento da fibrilação atrial. As demais etiologias são variadas, ocorrendo em menor frequência: algumas afecções neurológicas, como Parkinson e esclerose múltipla; doença de Chagas; endocrinopatias; miopatias; associadas a pseudo -obstrução intestinal; associadas a uso de medicamentos; e como manifestação paraneoplásica 5,6,9 .…”

“…Não se encontrou, na literatura, série de casos somente de pacientes geriátricos (acima de 60 anos). No entanto, supõe-se que algumas etiologias sejam mais prevalentes nesta faixa etária, como diabetes tipo 2, alterações degenerativas do sistema nervoso como doença de Parkinson, alterações isquêmicas de tronco celíaco, insuficiência renal crônica e amiloidose 5,6,9,10 .…”