title: Factors contributing to hospitalization for gastroparesis exacerbations.
abstract: BACKGROUND
  The clinical course of patients with gastroparesis is characterized by symptomatic exacerbations often necessitating hospitalization.
  
  
  OBJECTIVE
  To investigate precipitating factors leading to hospitalization for exacerbation of symptoms in patients with gastroparesis.
  
  
  METHODS
  This was a retrospective review of 103 admissions (63 patients) for gastroparesis exacerbation.
  
  
  RESULTS
  Etiologic categories for gastroparetic patients were diabetic (43%), idiopathic (39%), and post surgical (8%). Poor glycemic control was present in 36%, infection in 19% (12 urinary tract infections and two bacteremia), and noncompliance with or intolerance of, medications in six and 5% of patients, respectively. Fasting morning cortisol concentrations were \3 mcg/dl in 9%. Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were seen in 34 of 65 (52%) and 11 of 50 patients (22%), respectively. No identifiable infection was found in 74 and 45% of patients with elevated ESR and elevated CRP, respectively. ESR and CRP were higher when patients were symptomatic necessitating hospitalization (26.2 +/- 6.6 mm/h and 1.6 +/- 1.0 mg/l) compared with when they were seen in outpatient follow-up and less symptomatic (10.3 +/- 2.9 mm/h and 0.3 +/- 0.1 mg/l; P = 0.0001 and P = 0.211, respectively).
  
  
  CONCLUSIONS
  Poor glycemic control, infection, noncompliance with/intolerance of medications, and, perhaps, adrenal insufficiency were contributory factors leading to hospitalizations of gastroparetic patients. Hospitalized patients with gastroparesis exacerbations had elevated ESR and CRP levels. Although many patients with elevated inflammatory markers had evidence of infection, some did not. Assessment of inflammatory markers may help indicate those gastroparetic patients in whom a search for infection should be undertaken.
authors.affiliation: Gastroenterology Section, Department of Medicine, Temple University School of Medicine, Parkinson Pavilion, Philadelphia, PA 19140, USA.
authors.forename: Sesha S
authors.initials: SS
authors.lastname: Uppalapati
authors.forename: Zeeshan
authors.initials: Z
authors.lastname: Ramzan
authors.forename: Robert S
authors.initials: RS
authors.lastname: Fisher
authors.forename: Henry P
authors.initials: HP
authors.lastname: Parkman
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D005260:Female; D018589:Gastroparesis / Q000150:complications / Q000453:epidemiology*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D015415:Biomarkers