Gastroparesis and gastroparesis-like syndrome: response to therapy and its predictors.
OBJECTIVE
The natural history and outcome of patients with gastroparesis is not well known. The aim of this study was to identify the clinical or pathophysiological characteristics, if any, that may be helpful in predicting therapeutic response in this condition.


METHODS
This is a retrospective study of a cohort of patients who presented to a tertiary referral center with symptoms suggestive of gastroparesis. All patients were evaluated by scintigraphic measurement of gastric emptying and symptoms were scored using a modification of the Gastroparesis Cardinal Symptom Index (GCSI). Treatment generally included conservative measures such as antiemetics, prokinetics, tricyclic antidepressants, and analgesics as well as various more invasive interventions in selected patients. Response to treatment was defined as a change in the overall GCSI score of two-thirds or more as compared with baseline.


RESULTS
Out of a total of 93 patients, 69 patients met the eligibility criteria. Of these, 29 patients had diabetes mellitus and 40 patients had gastroparesis of nondiabetic etiology. Out of 69 patients, 49 were responders (71%) and 20 were nonresponders (29%). The cause (diabetic versus nondiabetic) of gastroparesis or the presence of delayed emptying did not correlate with response. However, the severity of stomach distension, bloating subscale score, and the global GCSI score at baseline presentation were predictive of response by multivariate analysis.


CONCLUSIONS
Higher global GCSI score, bloating subscale score, and severity of stomach distension at baseline presentation correlated with an unfavorable response in gastroparetic patients. On the other hand, neither the etiology of gastroparesis nor associated delay in gastric emptying appeared to be important in the clinical response. Patients with symptoms of typical gastroparesis but without delays in gastric emptying may have a distinct syndrome with a greater proportion of males than classical gastroparesis.
Anaparthy
Rajeswari
R
University of Texas Medical Branch, Galveston, TX, USA.
Pehlivanov
Nonko
N
Grady
James
J
Yimei
Han
H
Pasricha
Pankaj J
PJ
D015746:Abdominal Pain / Q000209:etiology / Q000628:therapy; D000328:Adult; D000368:Aged; D001066:Appetite; D003131:Combined Modality Therapy; D048909:Diabetes Complications / Q000628:therapy; D004359:Drug Therapy, Combination; D004599:Electric Stimulation Therapy; D005260:Female; D013271:Gastric Dilatation / Q000209:etiology / Q000628:therapy; D005746:Gastric Emptying; D005765:Gastrointestinal Agents / Q000627:therapeutic use*; D018589:Gastroparesis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology / Q000628:therapy; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013577:Syndrome; D017211:Treatment Failure; D016896:Treatment Outcome; D014839:Vomiting / Q000209:etiology / Q000628:therapy
D005765:Gastrointestinal Agents