Psychological controversies in gastroparesis: A systematic review

Woodhouse, Sally; Hebbard, Geoff; Knowles, Sandra R.

doi:10.3748/wjg.v23.i7.1298

Cited by 51 publications

(39 citation statements)

References 42 publications

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“…The same study found an increase in hospital charges for gastroparesis admissions from $13350 to $34585 over the same period. Gastroparesis has become of increasing relevance due to its association with poorer quality of life, significant psychological distress, anxiety and depression[ 3 - 6 ].…”

Section: Introductionmentioning

confidence: 99%

Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis

Qayed¹,

Muftah²

2018

WJGE

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AIMTo evaluate rates and predictors of hospital readmission and care fragmentation in patients hospitalized with gastroparesis.METHODSWe identified all adult hospitalizations with a primary diagnosis of gastroparesis in the 2010-2014 National Readmissions Database, which captures statewide readmissions. We excluded patients who died during the hospitalization, and calculated 30 and 90-d unplanned readmission and care fragmentation rates. Readmission to a non-index hospital (i.e., different from the hospital of the index admission) was considered as care fragmentation. A multivariate Cox regression model was used to analyze predictors of 30-d readmissions. Logistic regression was used to determine hospital and patient factors independently associated with 30-d care fragmentation. Patients readmitted within 30 d were followed for 60 d post discharge from the first readmission. Mortality during the first readmission, hospitalization cost, length of stay, and rates of 60-d readmission were compared between those with and without care fragmentation.RESULTSThere were 30064 admissions with a primary diagnosis of gastroparesis. The rates of 30 and 90-d readmissions were 26.8% and 45.6%, respectively. Younger age, male patient, diabetes, parenteral nutrition, ≥ 4 Elixhauser comorbidities, longer hospital stay (> 5 d), large and metropolitan hospital, and Medicaid insurance were associated with increased hazards of 30-d readmissions. Gastric surgery, routine discharge and private insurance were associated with lower 30-d readmissions. The rates of 30 and 90-d care fragmentation were 28.1% and 33.8%, respectively. Younger age, longer hospital stay (> 5 d), self-pay or Medicaid insurance were associated with increased risk of 30-d care fragmentation. Diabetes, enteral tube placement, parenteral nutrition, large metropolitan hospital, and routine discharge were associated with decreased risk of 30-d fragmentation. Patients who were readmitted to a non-index hospital had longer length of stay (6.5 vs 5.8 d, P = 0.03), and higher mean hospitalization cost ($15645 vs $12311, P < 0.0001), compared to those readmitted to the index hospital. There were no differences in mortality (1.0% vs 1.3%, P = 0.84), and 60-d readmission rate (55.3% vs 54.6%, P = 0.99) between the two groups.CONCLUSIONSeveral factors are associated with the high 30-d readmission and care fragmentation in gastroparesis. Knowledge of these predictors can play a role in implementing effective preventive interventions to high-risk patients.

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Section: Introductionmentioning

confidence: 99%

Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis

Qayed¹,

Muftah²

2018

WJGE

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“…A potential factor that we did not systematically take into account is the presence of psychiatric comorbidities, especially depression or anxiety disorder and whether patients underwent any specific treatment for these conditions that could have influenced treatment response to nutritional interventions. Literature data indicate that psychiatric comorbidities are frequent in patients with gastroparesis: combined anxiety/ depression in 24%, severe anxiety in 12%, depression in 23%, and somatization in 50% . Acute anxiety and stress are known for their profound influences on gastric motor function, in particular on gastric accommodation .…”

Section: Discussionmentioning

confidence: 99%

“…Literature data indicate that psychiatric comorbidities are frequent in patients with gastroparesis: combined anxiety/ depression in 24%, severe anxiety in 12%, depression in 23%, and somatization in 50%. 45 Acute anxiety and stress are known for their profound influences on gastric motor function, in particular on gastric accommodation. 46 In addition, psychoactive medication has been suggested to influence gastric TA B L E 2 Objective treatment outcomes in relation to subjective response N (total n = 86) Mean weight (kg) before (SD)…”

Section: Discussionmentioning

confidence: 99%

Therapeutic strategies in gastroparesis: Results of stepwise approach with diet and prokinetics, Gastric Rest, and PEG‐J: A retrospective analysis

Strijbos

Keszthelyi

Smeets

et al. 2019

Neurogastroenterology Motil

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Background Gastroparesis is characterized by abnormal gastric motor function with delayed gastric emptying in the absence of mechanical obstruction. In our tertiary referral center, patients are treated with a stepwise approach, starting with dietary advice and prokinetics, followed by three months of nasoduodenal tube feeding with “gastric rest.” When not successful, a percutaneous endoscopic gastrostomy with jejunal extension (PEG‐J) for long‐term enteral feeding is placed. Aim To evaluate the effect of this stepwise approach on weight and symptoms. Methods Analyses of data of all referred gastroparesis patients between 2008 and 2016. Key Results A total of 86 patients (71% female, 20‐87 years [mean 55.8 years]) were analyzed of whom 50 (58%) had adequate symptom responses to diet and prokinetics. The remaining 36 (decompensated gastroparesis) were treated with three months gastric rest. Symptom response rate was 47% (17/36). Significant weight gain was seen in all patients, independent of symptom response. In the remaining 19 symptom non‐responders, the enteral feeding was continued through PEG‐J. Treatment was effective (symptoms) in 37%, with significant weight gain in all. In 84% of patients, the PEG‐J is still in use (mean duration 962 days). Conclusions and Inferences Following a stepwise treatment approach in gastroparesis, adequate symptom response was reached in 86% of all patients. Weight gain was achieved in all patients, independent of symptom response. Diet and prokinetics were effective with regard to symptoms in 58%, temporary gastric rest in 47%, and PEG‐J as third step in 37% of patients.

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“…Many patients with delayed GE are asymptomatic; others have dyspepsia (i.e., mild-moderate indigestion, with or without a mild delay in GE) or GP, which is a syndrome characterized by moderatesevere upper gastrointestinal symptoms and delayed GE that suggest, but are not accompanied by, gastric outlet obstruction [5] . GP can markedly impair quality of life and up to 50% of patients have significant anxiety and/or depression [1,[6][7][8] . Woodhouse et.al, 2017…”

Section: Letter To the Editormentioning

confidence: 99%

“…reported combined anxiety/ depression in 24%, severe anxiety in 12%, depression in 23%, and somatization in 50% [6] . In diabetic patients (without neuropathy) and healthy controls, acute hyperglycemia will instead relax the proximal stomach, and suppress gastric electrical activity (e.g., reduced the frequency, propagation, and contraction of the antrum) in both fasting and post-prandial conditions, thereby slowing gastric emptying [9] .…”

Section: Letter To the Editormentioning

confidence: 99%

Domination of Gastric Complications Among Diabetic Patients

Mohiuddin

2019

Journal of Gastroenterology and Hepatology Research

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This letter covers the epidemiology, pathophysiology/complications and management of diabetic gastroparesis (DGP), and more broadly diabetic gastroenteropathy, which encompasses all the gastrointestinal manifestations of diabetes mellitus (DM). Hyperglycemia, autonomic neuropathy, and enteric neuromuscular inflammation and injury are implicated in the pathogenesis of delayed gastric emptying (GE). Initial options include dietary modifications, supplemental oral nutrition, and antiemetic and prokinetic medications. Patients with more severe symptoms may require a venting gastrostomy or jejunostomy and/or gastric electrical stimulation (GES). To date, few population-based studies have estimated the true prevalence and incidence of gastroparesis. Nonetheless, its prevalence appears to be rising, as does its incidence among minority populations, documented via hospitalizations, which can impose significant economic burdens on patients.

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Psychological controversies in gastroparesis: A systematic review

Cited by 51 publications

References 42 publications

Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis

Frequency of hospital readmission and care fragmentation in gastroparesis: A nationwide analysis

Therapeutic strategies in gastroparesis: Results of stepwise approach with diet and prokinetics, Gastric Rest, and PEG‐J: A retrospective analysis

Domination of Gastric Complications Among Diabetic Patients

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