Table 2.
Characteristics of patients with idiopathic gastroparesis with mild, moderate, or severe delay in 4-hour gastric emptying
| Severity of delay in gastric emptying at 4 hours* | |||||||
|---|---|---|---|---|---|---|---|
| Mild (N = 108) |
Moderate (N = 66) |
Severe (N = 68) |
P value‡ |
||||
| Characteristic | No. | Statistic† | No. | Statistic† | No. | Statistic† | |
| Demographic and lifestyle: | |||||||
| Age at enrollment (yrs) | 108 | 39.9 ± 14.1 | 66 | 42.9 ± 14.8 | 68 | 41.0 ± 13.2 | 0.38 |
| Gender: Females | 92 | 85.2% | 58 | 87.9% | 63 | 92.7% | 0.15 |
| Married: (yes vs no) | 67 | 62.0% | 38 | 57.6% | 38 | 55.9% | 0.40 |
| College degree or higher (yes vs no) | 37 | 34.3% | 23 | 34.9% | 19 | 27.9% | 0.42 |
| Income $50,000+ (yes vs no) | 74 | 68.5% | 37 | 56.1% | 28 | 41.2% | <0.001 |
| Ever smoked regularly (yes vs no)§ | 36 | 33.3% | 20 | 30.3% | 24 | 35.3% | 0.83 |
| Ever drink (past year) | 49 | 45.4% | 25 | 37.9% | 21 | 30.1% | 0.45 |
| Anthropometry: | |||||||
| Waist circumference (cm) | 108 | 83.7 ± 16.8 | 66 | 82.9 ± 18.4 | 68 | 88.6 ± 8.0 | 0.08 |
| Waist to hip ratio | 108 | 0.85 ± 0.09 | 66 | 0.84 ± 0.15 | 68 | 0.86 ± 0.08 | 0.04 |
| Overweight: (yes vs no)§ | 44 | 40.7% | 32 | 48.5% | 34 | 50.0% | 0.21 |
| BMI (kg/m2) | 108 | 25.3 ± 6.8 | 66 | 24.5 ± 5.4 | 68 | 26.8 ± 8.0 | 0.37 |
| Inflammatory markers: | |||||||
| C-reactive protein (CRP) (mg/dL) | 108 | 0.7 ± 1.4 | 66 | 0.6 ± 1.2 | 68 | 0.7 ± 1.0 | 0.65 |
| CRP elevated (> 0.8 mg/dL) | 23 | 21.3% | 10 | 15.2% | 18 | 26.5% | 0.52 |
| ESR rate (mm/hr)§ | 108 | 13.4 ± 13.3 | 66 | 13.1 ± 12.4 | 68 | 17.0 ± 19.0 | 0.49 |
| ESR elevated (> 20 mm/hr)§ | 23 | 21.3% | 11 | 16.7% | 16 | 23.5% | 0.60 |
| Psychological function inventories: | |||||||
| State Anxiety inventory average score | 108 | 44.3 ± 13.9 | 66 | 44.1 ± 13.9 | 68 | 47.6 ± 12.4 | 0.21 |
| State Anxiety inventory score ≥ 50 | 38 | 35.2% | 21 | 31.8% | 28 | 41.2% | 0.09 |
| Trait Anxiety inventory average score | 108 | 43.0 ± 12.8 | 66 | 43.3 ± 11.8 | 68 | 45.9 ± 8.0 | 0.20 |
| Trait Anxiety inventory score ≥ 50 | 35 | 32.4% | 23 | 34.9% | 26 | 38.2% | 0.24 |
| Beck Depression Inventory avg score | 108 | 18.1 ± 10.6 | 66 | 17.1 ± 9.6 | 68 | 20.9 ± 11.9 | 0.18 |
| Beck Depression inventory > 28 | 18 | 16.7% | 8 | 12.1% | 18 | 26.5% | 0.08 |
| Medical history: | |||||||
| Co-morbidities: | |||||||
| Average number of co-morbidities | 108 | 3.13 ± 2.01 | 66 | 3.35 ± 2.80 | 68 | 4.72 ± 3.23 | 0.002 |
| Migraine Headache (yes vs no) | 43 | 39.8% | 25 | 37.9% | 31 | 45.6% | 0.63 |
| Chronic fatigue syndrome (yes vs no) | 5 | 4.6% | 6 | 9.1% | 11 | 16.2% | 0.01 |
| Fibromyalgia (yes vs no) | 4 | 3.7% | 11 | 16.7% | 16 | 23.5% | < 0.001 |
| Major depression (yes vs no) | 17 | 15.7% | 13 | 19.7% | 23 | 33.8% | 0.006 |
| Severe anxiety (yes vs no) | 12 | 11.1% | 5 | 7.6% | 13 | 19.1% | 0.13 |
| Co-medications: | |||||||
| Gastric acid suppressants (yes vs no) | 77 | 71.3% | 50 | 75.8% | 58 | 85.3% | 0.04 |
| Prokinetics (yes vs no) | 48 | 44.4% | 31 | 47.0% | 38 | 55.9% | 0.15 |
| Anti-emetics (yes vs no) | 74 | 68.5% | 38 | 57.6% | 61 | 89.7% | < 0.001 |
| Estrogen, progesterone,OCP’s (yes) | 28 | 25.9% | 14 | 21.2% | 16 | 23.5% | 0.78 |
| Narcotic pain medications (yes vs no) | 35 | 32.4% | 29 | 43.9% | 39 | 57.4% | 0.001 |
| Total enteral/parenteral support (yes/no) | 11 | 10.2% | 4 | 6.1% | 13 | 19.1% | 0.05 |
| Post-menopausal (yes vs no) | 28 | 30.4% | 22 | 37.9% | 17 | 27.0% | 0.42 |
| Age at symptom onset (years) | 108 | 35.7 ± 14.5 | 66 | 38.2 ± 15.4 | 68 | 35.1 ± 14.2 | 0.42 |
| Duration of symptoms at enrollment(yrs) | 108 | 4.2 ± 5.2 | 66 | 4.7 ± 7.1 | 68 | 5.9 ± 7.6 | 0.09 |
| Initial infectious prodrome: (yes vs no) | 26 | 24.1% | 12 | 18.5% | 7 | 10.3% | 0.02 |
| Predominant symptom: | |||||||
| Nausea vs all others | 38 | 35.2% | 20 | 30.3% | 24 | 35.3% | 0.77 |
| Vomiting vs all others | 17 | 15.7% | 16 | 24.2% | 14 | 20.6% | 0.37 |
| Abdominal pain vs all others | 25 | 23.2% | 13 | 19.7% | 18 | 26.5% | 0.68 |
| Type of gastroparesis symptom onset: | 0.37 | ||||||
| Acute start | 57 | 52.8% | 34 | 51.5% | 31 | 45.6% | |
| Insidious start | 51 | 47.2% | 32 | 48.5% | 37 | 54.4% | |
| Nature of gastroparesis symptoms: | 0.24 | ||||||
| Chronic, but stable | 21 | 19.4% | 21 | 31.8% | 12 | 17.7% | |
| Chronic, but progressively worse | 35 | 32.4% | 19 | 28.8% | 28 | 41.2% | |
| Chronic with periodic exacerbations | 38 | 35.2% | 22 | 33.3% | 19 | 27.9% | |
| Cyclic pattern | 13 | 12.0% | 4 | 6.1% | 9 | 13.2% | |
| Gastroparesis severity: | 0.17 | ||||||
| Mild (grade 1) | 13 | 12.0% | 11 | 16.7% | 10 | 14.7% | |
| Compensated (grade 2) | 61 | 56.5% | 43 | 65.2% | 33 | 48.5% | |
| Gastric failure (grade 3) | 34 | 31.5% | 12 | 18.2% | 24 | 35.3% | |
| Gastric failure vs less severe | 34 | 31.5% | 12 | 18.2% | 24 | 35.3% | 0.06 |
| Irritable bowel syndrome or IBS§ | 0.04 | ||||||
| Yes, pending exam/test | 63 | 58.3% | 44 | 66.7% | 50 | 73.5% | |
| No | 45 | 41.7% | 22 | 33.3% | 18 | 26.5% | |
| Gastric emptying (scintigraphy): | |||||||
| Percent gastric retention at 4 hr. | 108 | 13.3 ± 4.7 | 66 | 26.2 ± 4.1 | 68 | 53.5 ± 14.5 | < 0.001 |
| Severity of symptoms:§ | |||||||
| Nausea severity | 108 | 3.3 ± 1.6 | 68 | 3.4 ± 1.3 | 68 | 3.8 ± 1.2 | 0.05 |
| Retching severity | 108 | 1.7 ± 1.7 | 66 | 1.5 ± 1.6 | 68 | 2.3 ± 1.9 | 0.02 |
| Vomiting severity | 108 | 1.8 ± 1.9 | 66 | 1.7 ± 1.9 | 68 | 2.5 ± 1.9 | 0.01 |
| Stomach fullness severity | 106 | 3.7 ± 1.2 | 66 | 3.7 ± 1.1 | 68 | 3.8 ± 1.2 | 0.51 |
| Inability to finish meal severity | 108 | 3.4 ± 1.5 | 66 | 3.6 ± 1.3 | 68 | 3.8 ± 1.2 | 0.41 |
| Excessively full post meal severity | 108 | 3.6 ± 1.3 | 66 | 3.7 ± 1.3 | 68 | 3.9 ± 1.1 | 0.59 |
| Loss of appetite severity | 108 | 2.8 ± 1.6 | 66 | 3.2 ± 1.4 | 68 | 3.4 ± 1.4 | 0.04 |
| Bloating severity | 108 | 3.2 ± 1.7 | 66 | 3.3 ± 1.4 | 68 | 3.4 ± 1.4 | 0.71 |
| Visibly larger stomach severity | 108 | 2.8 ± 1.9 | 66 | 2.9 ± 1.8 | 68 | 3.0 ± 1.7 | 0.75 |
| Cardinal symptom index (GCSI)§ | 106 | 2.9 ± 1.1 | 66 | 2.9 ± 0.8 | 68 | 3.3 ± 1.0 | 0.04 |
| Upper abdominal pain | 108 | 2.9 ± 1.8 | 66 | 3.1 ± 1.5 | 68 | 3.5 ± 1.6 | 0.12 |
| Upper abdominal discomfort | 108 | 3.1 ± 1.6 | 66 | 3.4 ± 1.3 | 68 | 3.7 ± 1.4 | 0.05 |
| Lower abdominal pain | 108 | 2.0 ± 1.8 | 66 | 2.2 ± 1.4 | 68 | 2.5 ± 1.8 | 0.20 |
| Lower abdominal discomfort | 108 | 2.1 ± 1.7 | 66 | 2.4 ± 1.5 | 68 | 2.6 ± 1.8 | 0.18 |
| GERD sub-scale | 108 | 1.9 ± 1.4 | 66 | 1.8 ± 1.3 | 68 | 2.5 ± 1.4 | 0.007 |
| Constipation severity | 108 | 2.2 ± 1.8 | 66 | 2.7 ± 1.6 | 68 | 2.7 ± 1.9 | 0.10 |
| Diarrhea severity | 108 | 2.0 ± 1.7 | 66 | 1.6 ± 1.6 | 68 | 2.0 ± 1.8 | 0.21 |
*
Percent gastric retention at 4-hours: Mild= 20% or less, Moderate= 21% to 35%, Severe= >35%.
†
Means ± standard deviations or percents (%).
‡
The significance of difference in categorical variables between groups was tested with either a chi-square test or Fisher’s Exact Test for non-ordered categories, the Cochran-Armitage test for trend for ordered categories, or with the Wilcoxon rank sum test for continuous measures. All P values are two-sided.
§
Definitions:
Ever smoked regularly defined as smoking ≥ 20 packs of cigarettes in a lifetime or ≥ 1 cigarette per day for a year.
Overweight = BMI ≥ 25 kg/m2
ESR = Erythrocyte sedimentation rate
Irritable Bowel Syndrome or IBS diagnosis determined from the Rome III Diagnostic Questionnaire analyzed using an analysis program developed by the Rome Foundation (http://www.romecriteria.org/rome_iii_sas/, accessed 03 February 2010).
Symptom severity from the PAGI-SYM (Patient Assessment of GI Symptoms) questionnaire, scores range from 0–5
Gastroparesis cardinal symptom index (GCSI) = mean of the sub-scores for nausea, postprandial fullness, and bloating.