Observational Study
Copyright ©The Author(s) 2017.
World J Gastroenterol. Oct 28, 2017; 23(40): 7310-7320
Published online Oct 28, 2017. doi: 10.3748/wjg.v23.i40.7310
Table 1 Patients with gastroparesis referred to a tertiary care center between May 2016 and July 2017
ClassificationTotalChronic scheduled opioidsPRN opioidsNo opioids
Idiopathic12223693
Diabetic6215938
Post-surgical1202513
Atypical2193214
Total2234322158
1Post-surgical gastroparesis consisted of patients with history of duodenal-jejunostomy, esophagectomy, fundoplication, gastric sleeve, gastric banding, gastric bypass, hiatal hernia repair, and vagotomy with pyloroplasty.
2Atypical gastroparesis consisted of gastroparesis patients with history of Bulimia, Complex Regional Pain Syndrome, Ehlers Danlos Syndrome, Lupus, Parkinson’s Disease, Reflux Sympathetic Dystrophy, Scleroderma and Sjogren’s Syndrome.
Table 2 Gastroparesis patients: Demographics, employment, social history, laboratory tests and gastric emptying test in chronic opioid using gastroparesis patients, and patients with no opioid use
Chronic scheduled opioidsNo opioidsP value
Age (median in years with IQR)49.0 (34.0-56.0)441.0 (30.0-55.0)0.091
Age symptoms started (median in years with IQR)40.0 (24.3-52.0)433 (22.8-47.3)0.281
Average duration of symptoms (median in years)43.0 (1.0-15.5)44.0 (1.0-10.0)0.937
Previously established diagnosis of Gp (%)90.7% (39/43)86.7% (137/158)0.482
Female (%)74.4% (32/43)81.0% (128/158)0.341
Body mass Index (median in kg/m2 with IQR)424..3 (22.1-29.3)424.7 (20.3-30.8)0.983
Race (% White)83.3% (35/42)83.9% (125/149)0.917
Residing outside catchment area (50 miles)53.5% (23/43)51.6% (80/155)0.828
Diabetes (%)35.7% (15/42)25.9% (41/158)0.055
Surgery on stomach/esophagus (%)28.6% (12/42)19.1% (28/147)0.136
Employed (%)33.3% (14/42)54.2% (84/155)0.016
Working hours per week (median with IQR)23.0 (10.5-35.0)440 (24.5-40.0)0.005
Smoking history, current or past (%)46.3% (19/41)31.2% (48/154)0.069
Current smoker (%)31.7% (13/41)13.0% (20/154)0.004
Alcohol history, current or past (%)23.8% (10/42)37.4% (58/155)0.100
Current alcohol use (%)7.3% (3/41)20.0% (30/150)0.057
Random cortisol (% with low cortisol1)16.2% (6/37)10.4% (11/106)0.345
Hemoglobin A1c (median with IQR)45.9% (5.3%-7.7%)45.7% (5.4%-6.4%)0.377
Thyroid stimulating hormone (% with high TSH2)4.9% (2/41)1.7% (2/116)0.271
Trypsinogen (% with low trypsinogen3)23.1% (6/26)4.2% (3/72)0.004
History of chronic pancreatitis7.0% (3/43)1.3% (2/158)0.033
Gastric emptying scintigraphy: Retention at 2 h (median with IQR)62% (50%-80%)466% (50%-72%)0.359
Gastric emptying scintigraphy: Retention at 4 h (median with IQR)422% (14%-42%)424% (15%-35%)0.522
1Low cortisol: AM less than 6.2 μg/dL (171 nmol/L), PM less than 2.3 μg/dL (63.4 μg/dL);
2High TSH: Greater than 4.50 μIU/mL;
3Low trypsinogen: Less than 19 ng/mL.
4Results with non-normal distribution. Results expressed as median ± interquartile range, or percentage as appropriate. Gp: Gastroparesis; IQR: Interquartile range; TSH: Thyroid stimulating hormone.
Table 3 Comparison of gastric emptying scintigraphy results at different morphine equivalents per day in gastroparesis patients on chronic opioids using analysis of variance
Gastric emptying scintigraphy1st quartile (≤ 22.5 mg of morphine equivalents per day)2nd quartile (> 22.5 mg/d, and ≤ 60 mg/d)3rd quartile (> 60 mg/d, and ≤ 112.5 mg/d)4th quartile(> 112.5 mg/d)P value
Retention at 2 h (mean ± SEM)68% ± 6%54% ± 8%84% ± 5%60% ± 9%0.157
Retention at 4 h (mean ± SEM)31% ± 7%21% ± 8%37% ± 10%36% ± 19%0.678
SEM: Standard error of mean.
Table 4 Symptom Severity as assessed with Patient Assessment of Upper Gastrointestinal Symptoms questionnaire; comparison between gastroparesis patients on chronic opioids and patients with no opioid use
GI symptomGpCO (n = 43)GpNO (n = 158)P value
Nausea4.09 ± 0.123.41 ± 0.120.011
Retching2.86 ± 0.251.98 ± 0.140.003
Vomiting2.93 ± 0.242.07 ± 0.150.011
Stomach fullness3.84 ± 0.183.59 ± 0.110.254
Early satiety4.17 ± 0.193.57 ± 0.120.004
Post prandial fullness4.14 ± 0.183.63 ± 0.110.022
Loss of appetite3.64 ± 0.213.04 ± 0.130.039
Bloating3.67 ± 0.193.36 ± 0.130.396
Abdominal distension2.95 ± 0.253.01 ± 0.140.753
Upper AP3.86 ± 0.202.93 ± 0.130.001
Upper abdominal discomfort3.74 ± 0.193.09 ± 0.130.031
Lower AP2.67 ± 0.272.38 ± 0.130.315
Lower abdominal discomfort2.79 ± 0.252.38 ± 0.130.130
Heartburn during day2.55 ± 0.271.89 ± 0.130.032
Heartburn on lying down2.76 ± 0.281.94 ± 0.140.008
Chest discomfort during day2.42 ± 0.201.83 ± 0.120.018
Chest discomfort at night2.40 ± 0.231.61 ± 0.130.003
Regurgitation or reflux during day2.77 ± 0.252.18 ± 0.130.040
Regurgitation or reflux on lying down2.64 ± 0.282.21 ± 0.140.120
Bitter/acid/sour taste2.79 ± 0.272.11 ± 0.140.028
Constipation2.92 ± 0.302.63 ± 0.140.296
Diarrhea1.80 ± 0.301.79 ± 0.140.891
Total Symptom Severity Score68.40 ± 2.8256.63 ± 1.770.001
1Results with non-normal distribution. Results expressed as median with interquartile range, and percentage as appropriate. AP: Abdominal pain; BMs: Bowel movements; GpCO: Gastroparesis patients on chronic opioids; GpNO: Gastroparesis patients not on opioids.
Table 5 Comparison of gastrointestinal symptoms between gastroparesis patients on chronic opioids and patients with no opioid use trial[10,11,27]
GpCOGpNOP value
Episodes of vomiting in last 1 wk13.0 (1.0-7.0)11.0 (0.0-3.0)0.002
Hours of nausea/day in last 1 wk17.0 (3.0-18.0)14 (1.5-12.0)0.037
Total number of BMs in last 1 wk14.0 (2.0-7.0)4.0 (2.0-7.0)0.714
AP one of the symptoms (%)84.1% (37/43)85.2% (132/155)0.861
Duration of AP (yr)12.0 (0.5-4.0)11.5 (0.7-4.5)0.526
Location of most severe APUmbilical 41.7% (15/36)Epigastric 44.2% (57/129)0.863
AP wakes up at night (%)78.1% (7/32)57.3% (71/124)0.031
AP worse with meals (%)76.5% (26/34)80.0% (100/125)0.508
1Results with non-normal distribution. Results expressed as median with interquartile range, and percentage as appropriate. AP: Abdominal pain; BMs: Bowel movements; GpCO: Gastroparesis patients on chronic opioids; GpNO: Gastroparesis patients not on opioids.
Table 6 Frequency of symptoms in the past 3 mo using Rome IV questionnaire: comparison between gastroparesis patients with chronic scheduled opioid use and patients with no opioid use (percentage of patients with symptoms once a week or more often)
SymptomGpCOGpNOP value
Post-prandial fullness interfering with activities81.6% (31/38)78.7% (118/150)0.692
Unable to finish regular sized meal due to fullness84.6% (33/39)79.1% (117/148)0.438
Epigastric pain/burning interfering with activities75.0% (30/40)66.9% (103/154)0.324
Nausea interfering with activities92.5% (37/40)76.0% (117/154)0.021
Vomiting70.7% (29/41)50.6% (78/154)0.022
Bloating or stomach distension72.5% (29/40)68.8% (106/154)0.653
Belching interfering with activities62.5% (25/40)51.3% (79/154)0.206
GpCO: Gastroparesis patients on chronic opioids; GpNO: Gastroparesis patients not on opioids.
Table 7 Comparison of healthcare utilization between chronic opioid using gastroparesis patients and patients with no opioid use
GpCO(n = 43)GpNO(n = 158)P value
ER visits in last 1 yr from Gp5.13 ± 1.463.74 ± 0.650.468
Hospital admissions in last 1 yr from Gp2.90 ± 0.771.26 ± 0.230.047
Results expressed as mean ± SE of mean. ER: Emergency room; GpCO: Gastroparesis patients on chronic opioids; GpNO: Gastroparesis patients not on opioids.