Characterization of Patients With Symptoms of Gastroparesis Having Frequent Emergency Department Visits and Hospitalizations.

BACKGROUND & AIMS: Patients with gastroparesis (Gp) can be high users of the medical system. In this study, we characterized patients with Gp symptoms who had frequent emergency department (ED) visits and hospitalizations. METHODS: Patients with symptoms of Gp underwent history and physical examination, gastric emptying scintigraphy (GES), and questionnaires capturing number of ED visits and hospitalizations over the prior year, GI symptoms (Patient Assessment of Upper GI Symptoms [PAGI-SYM]), anxiety and depression [Hospital Anxiety and Depression Scale (HADS)], somatization [Patient Health Questionnaire (PHQ-15)], and quality of life (SF-36v2 and Patient Assessment of Upper GastroIntestinal Disorders-Quality of Life [PAGI-QOL]). RESULTS: Of 406 patients with symptoms of Gp (294; 72.4%) had delayed gastric emptying (33% diabetic, 61% idiopathic, 6% postfundoplication), 159 patients (39%) had prior ED visits. Baseline characteristics that were independently associated with ED visits over the prior year included younger age, Black race, lower income, higher gastric retention on GES at 4 hours, antiemetic medication use, cannabis use, jejunostomy tube presence, and higher nausea/vomiting scores. Ninety-two patients (23%) had hospitalizations due to symptoms of Gp over the prior year. The most frequent reasons for hospitalizations included nausea (83%), vomiting (78%), abdominal pain (70%), and dehydration (59%). Baseline characteristics that were independently associated with increased hospitalizations were younger age, Black race, lower income, diabetic etiology, greater 4-hour gastric retention, prokinetic use, cannabis use, jejunostomy tube presence, higher nausea/vomiting scores, and higher depression scores. CONCLUSIONS: Our study of patients with symptoms of Gp revealed a sizeable subset have had Gp-related ED visits and hospitalizations over the past year. Several factors related to etiology, GE delay, GI symptom severity, depression severity, race, and lower income were associated with ED visits and hospitalizations. CLINICALTRIALS: gov Identifier: N3CT01696747.

Duke Scholars

Author Bruno Chumpitazi Pediatrics, Gastroenterology, Hepatology and Nutrition