Gastroparesis natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2]
Overview
Natural History
The natural history of gastroparesis is largely unknown. One study suggested that symptoms and gastric emptying in 20 patients with diabetes were generally stable over 12 years of follow-up. In another study of 86 diabetic patients who were followed for at least 9 years, delayed gastric emptying was not related with mortality after adjustment of comorbidities. However, other data from a tertiary setting over 6 years follow-up observed that 7% had died and 22% needed long-term parenteral or enteral feeding, suggesting gastroparesis is not a benign condition. Community studies of the outcome of gastroparesis are lacking, and studies conducted in tertiary referral centers may not reflect findings encountered in the general population.
Minimal data are available on the natural history of diabetic gastroparesis. From a group of 86 patients assessed at a tertiary referral center, 20 patients, of whom 16 had T1DM, were reevaluated 12 years later and only 13 patients (12 had T1DM) were reevaluated approximately 25 years after the first study.23,29 Although GE was not significantly different 25 years after the baseline assessment, correlation between initial and subsequent assessments was limited, as evidenced by a correlation coefficient of 0.56.23
In the Olmsted County epidemiology study, of all the incident cases of gastroparesis, one third patients died and another one third required medications, hospitalization or tube feeding related to gastroparesis. There are limited data on long term natural history of gastroparesis.[1]
Complications
Primary complications of gastroparesis include:
- Fluctuations in blood glucose due to unpredictable digestion times (in diabetic patients)
- General malnutrition due to the symptoms of the disease (which frequently include vomiting and reduced appetite) as well as the dietary changes necessary to manage it
- Severe fatigue and weight loss due to calorie deficit
- Intestinal obstruction due to the formation of bezoars (solid masses of undigested food)
- Bacterial infection due to overgrowth in undigested food
- Dehydration
- Electrolyte imbalances
Prognosis
Many treatments seem to provide only temporary benefit. The estimated 5-year survival for gastroparesis based on Gastroparesis study in Olmsted County, MN, as of January 1, 2007 was 67% with worse prognosis for diabetic gastroparesis.[2] Prognosis of diabetic gastroparesis mainly depends upon blood sugar level and duration of diabetes.
References
- ↑ Bharucha AE (2015). "Epidemiology and natural history of gastroparesis". Gastroenterol Clin North Am. 44 (1): 9–19. doi:10.1016/j.gtc.2014.11.002. PMC 4323583. PMID 25667019.
- ↑ Jung HK, Choung RS, Locke GR, Schleck CD, Zinsmeister AR, Szarka LA; et al. (2009). "The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006". Gastroenterology. 136 (4): 1225–33. doi:10.1053/j.gastro.2008.12.047. PMC 2705939. PMID 19249393.