Hospitalizations and testing in gastroparesis

Background and Aim: Gastroparesis significantly impairs the quality of life in affected individuals and may lead to repeat hospitalizations due to refractory symptoms. We hypothesized that pain is a key reason for emergency encounters and diagnostic testing. Methods: Using the ICD9 code 536.3, electronic medical records were analyzed retrospectively. Multivariate regression was used to determine predictors of hospital stays and use of diagnostic testing. Results: In total, 326 patients (80% women, age: 44.1 +/- 0.8 years) were identified. During 504 patient-years of follow up, patients were hospitalized on average slightly more than once annually for about 8 days and underwent 320 endoscopies, 366 computed tomography scans, 390 abdominal X-rays, 90 upper gastrointestinal contrast studies and 163 gastric emptying studies; 37 patients exceeded an annual radiation exposure of 20 mSv at least once. The majority of tests were confirmatory, with results not altering treatment. Vomiting and pain were the most common cause for emergency encounters and diagnostic testing. Age and comorbidity, but not opioid use (present in 25%) or the presence of chronic pain disorders (present in 32%) correlated with increased hospital days. Conclusions: While surrogate markers of pain do not predict repeat hospitalizations, pain was the primary reason for emergency encounters and frequent diagnostic testing. Repeated testing had a limited impact on treatment and outcome, but certainly contributes to the cost and even risk of care. Concerted efforts are needed to not only improve the care and quality of life of patients with gastroparesis, but also to reduce the number of potentially unnecessary or even harmful interventions.