Demography, Clinical Characteristics, Psychological and Abuse Profiles, Treatment, and Long-Term Follow-up of Patients with Gastroparesis
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Patients with gastroparesis frequently presentchallenging clinical, diagnostic, and therapeuticproblems. Data from 146 gastroparesis patients seen oversix years were analyzed. Patients were evaluated at the time of initial diagnosis and at themost recent follow-up in terms of gastric emptying andgastrointestinal symptomatology. The psychologicalstatus and physical and sexual abuse history in female idiopathic gastroparesis patients wereascertained and an association between those factors andgastrointestinal symptomatology was sought. Eightytwopercent of patients were females (mean age: 45 years old). The mean age for onset of gastroparesiswas 33.7 years. The etiologies in 146 patients are: 36%idiopathic, 29% diabetic, 13% postgastric surgery, 7.5%Parkinson's disease, 4.8% collagen vascular disorders, 4.1% intestinal pseudoobstruction,and 6% miscellaneous causes. Subgroups were identifiedwithin the idiopathic group: 12 patients (23%) had apresentation consistent with a viral etiology, 48% had very prominent abdominal pain. Othersubgroups were gastroesophageal reflux disease andnonulcer dyspepsia (19%), depression (23%), and onset ofsymptoms immediately after cholecystectomy (8%).Sixty-two percent of women with idiopathic gastroparesisreported a history of physical or sexual abuse, andphysical abuse was significantly associated withabdominal pain, somatization, depression, and lifetime surgeries. At the end of the follow-up period,74% required continuous prokinetic therapy, 22% wereable to stop prokinetics, 5% had undergone gastrectomy,6.2% went onto gastric electrical stimulation (pacing), and 7% had died. At some point 21%had required nutrition support with a feedingjejunostomy tube or periods of parenteral nutrition. Agood response to pharmacological agents can be expected in the viral and dyspeptic subgroups ofidiopathics, Parkinson's disease, and the majority ofdiabetics, whereas a poorer outcome to prokinetics canbe expected in postgastrectomy patients, those withconnective tissue disease, a subgroup of diabetics, andthe subset of idiopathic gastroparesis dominated byabdominal pain and history of physical and sexual abuse.Appreciation of the different etiologies andpsychological status of the patients may help predictresponse to prokinetic therapy.
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