Presenting Symptoms and Diagnostic Work-up in Patients With Gastroparesis at a Tertiary-care Center

Introduction: Gastroparesis is a condition characterized by delayed gastric emptying in the absence of mechanical gastric outlet obstruction. Symptoms of gastroparesis include early satiety, post-prandial fullness, bloating, nausea, vomiting and abdominal discomfort. Gastric emptying scintigraphy (GES) is the gold standard for diagnosis of gastroparesis. Structural evaluation with esophagogastroduodenoscopy (EGD) or radiographic study is required to exclude mechanical obstruction prior to establishing a diagnosis of gastroparesis. We conducted a retrospective study to evaluate the presenting symptoms and diagnostic work-up in patients with gastroparesis. Methods: A retrospective study at a single tertiary-care center was performed after IRB approval. All adult patients that underwent GES at our hospital from January 2013 through August 2014 were included. Patient charts were reviewed for the following data: Age, gender, presenting symptoms, indications and results of GES, etiologies of gastroparesis, and EGD findings. Results: A total of 600 patients who underwent GES were identified consisting of 154 males and 446 females with mean age 47.7 ± 16.4 years. The most common indications for GES were nausea (n=284, 47.3%), abdominal pain (n=231, 38.5%), bloating (n=207, 34.5%), vomiting (n=185, 30.8%), and early satiety (n=59, 9.8%). There were 304 symptomatic patients with an abnormal or delayed GES (50.7%). The most common symptoms associated with delayed GES were nausea (n=147, 48.4%), abdominal pain (n=108, 35.5%), bloating (n=100, 32.9%), vomiting (n=91, 29.9%), and early satiety (n=22, 7.2%). The most common etiology for gastroparesis was diabetes mellitus found in 27.6% (84/304) patients. EGD was performed in 241 out of 304 patients who were diagnosed with gastroparesis. There were 63 patients (20.7%) who were diagnosed with gastroparesis without performing EGD to rule out mechanical obstruction. Conclusion: Gastroparesis was diagnosed in >50% symptomatic patients who were referred for GES. Mechanical obstruction was not ruled out in >20% symptomatic patients who were diagnosed with gastroparesis.