Hospitalizations and testing in

gastroparesis
Anwar Dudekula, Michael OConnell and Klaus
Bielefeldt
Journal of Gastroenterology and Hepatology 26 (2011) 12751282
Journal Reading
I!"OD#C!IO
$astroparesis defined by dela%ed e&pt%ing of
the sto&ach with chronic s%&pto&s, nausea,
'o&iting, postprandial (loating and)or
disco&fort*
Hospitaliation rates and duration of inpatient
stays in!rease disproportionally long
patient !on!erns" dra#ati! presentation repeated
$o#iting or pain %ospitaliation and repeated
diagnosti! testing&
2
Methods

!he stud% design + retrospecti'e chart

re'iew of patients in, or outpatient clinic of
the #ni'ersit% of -itts(urgh Medical Center
(etween .anuar% /001 and Dece&(er /002

Multi'ariate regression was used to

deter&ine predictors of hospital sta%s and
use of diagnostic testing*

!he stud% design + retrospecti'e chart

re'iew of patients in, or outpatient clinic of
the #ni'ersit% of -itts(urgh Medical Center
(etween .anuar% /001 and Dece&(er /002

Multi'ariate regression was used to

deter&ine predictors of hospital sta%s and
use of diagnostic testing*
'n!lusion
(elayed gastri! e#ptying
s!intigrap%y!ally (definite)
or !onfir#ed by endos!opi!
or radiograp%i! e$iden!e of
retained food in t%e
sto#a!% after 12 % of
fasting (probable)
)t least 1 typi!al sy#pto#
(nausea"$o#iting"postprandial
bloating"anore*ia"epigastri!
dis!o#fort) present #ore t%an
2 #ont%s
+*!lusion
(id not #eet in!lusion
!riteria
%ad gastri! outlet
obstru!tion or !%roni!
intestinal pseudoobstru!tion&
De&ographic infor&ation
Clinic encounters
underl%ing etiolog%
Emergency room visits,
-s%chiatric disorders
hospitalizations, hospital
days
Chronic pain s%ndro&e
3(ack pain, fi(ro&%algia,
headache4
diagnostic tests (upper
endoscopy, abdominal
CT, upper GI X-ray
gastric emptying studies)
the 5uantitati'e dela% in
gastric e&pt%ing of solids
and &edication use
The time beteen the inde!
and last encounter as
de"ined as "ollo up&
(ata abstra!tion fro# #edi!al re!ord
(
Hospitalization

#$% patient-years o" "ollo up&'%' visits

gastroenterologists, &$%# E( visits, )'& hospitalizations, total
%')# hospital days*

+ore clinic visits too, place during the "irst year (- . $*$&)
compared to years / through #, E( visits and hospitalization
rates did not vary signi"icantly beteen the years
"esults
,ost surgi!al
-.(
(/
'diopat%i!
,ost infe!tion
6ndoscop%

&%# endoscopies in %% patients ith time beteen

procedures o" &/*0 1&*2 months*

Indications3 nausea vomiting (/24), abdominal pain

(/&4), insertion enteral "eeding tube (&04), esophageal
symptoms (54), hematemesis ('4) or pyloric botulinum
to!in in6ection ('4)

(/#4) ere directly related to treatment and7or

demonstrated "indings that altered therapy

The remaining endoscopies did not show relevant

changes influenced treatment*
I&aging

/07 a(do&inal C! scans perfor&ed in

11 patients

&ain indication+ a(do&inal pain

389:4 of the listed reasons, followed
(% nausea 'o&iting 39:4

Association utilization and coe;isting chronic

pain s%ndro&e 3a4, opioid use 3(4 and
ps%chiatric co&or(idit% 3c4

"esults that alter patient &anage&ent were

identified in /0 37<:4 of the C! scans
0o pain $s pain
0o opioid $s opioid
0o psy $s psy
Disscussion

gastroparesis significant (urden for patients

and healthcare s%ste&, &ore than one third
re5uires e&ergenc% &edical care and
hospitalizations

6" 'isits and hospitalizations correlated with

diagnostic testing, endoscopies, a(do&inal =,
ra%s and C! scans

few results trul% affected therap% and thus

potentiall% altered outco&e
Disscussion

1e %ypot%esied pain is i#portant fa!tor

in resour!e utiliation

.%e ordering patterns for diagnosti!

testing 2ere !ertainly !onsistent &ost
C! scans and endoscop% listed
a(do&inal pain as &ain indication
>i&itations

large retrospe!ti$e !o%ort study in a tertiar%

referral center biased #ore !o#ple*
group re3uire #ore e*tensi$e !are

only 104 probable gastroparesis based on

food retention after a fast perfor#ed at
different ti#e and institutionsli#its dire!tly
!o#pare results

5nly !ases 2it% ele!troni! #edi!al re!ord

Conclusion

+ 7+ 1 patients e*perien!e signifi!ant sy#pto#s

fre3uent +R $isits" %ospitaliations and
diagnosti! testing

Dra&atic s%&pto&s (repeated $o#iting

abdo#inal pain" frustration) p* and p%ysi!ians
repeatedl% seek e;planations (e%ond the
known i&pair&ent of gastric function&
conclusion

&ost tests are onl% confir&ator%,

e;cluding unlikel% find other pro(le&s

increasing costs and unnecessar%

risks*

eed to educate patients and ph%sicians

a(out the li&ited utilit% and potential

har& of repeat assess&ents in chronic
functional disorders of the $I tract*
!HAK ?O#