TY - JOUR
T1 - Factors contributing to hospitalization for gastroparesis exacerbations
AU - Uppalapati, Sesha S.
AU - Ramzan, Zeeshan
AU - Fisher, Robert S.
AU - Parkman, Henry P.
PY - 2009/11/1
Y1 - 2009/11/1
N2 - Background: The clinical course of patients with gastroparesis is characterized by symptomatic exacerbations often necessitating hospitalization. Aims: To investigate precipitating factors leading to hospitalization for exacerbation of symptoms in patients with gastroparesis. Methods: This was a retrospective review of 103 admissions (63 patients) for gastroparesis exacerbation. Results: Etiologic categories for gastroparetic patients were diabetic (43%), idiopathic (39%), and post surgical (8%). Poor glycemic control was present in 36%, infection in 19% (12 urinary tract infections and two bacteremia), and noncompliance with or intolerance of, medications in six and 5% of patients, respectively. Fasting morning cortisol concentrations were <3 mcg/dl in 9%. Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were seen in 34 of 65 (52%) and 11 of 50 patients (22%), respectively. No identifiable infection was found in 74 and 45% of patients with elevated ESR and elevated CRP, respectively. ESR and CRP were higher when patients were symptomatic necessitating hospitalization (26.2 ± 6.6 mm/h and 1.6 ± 1.0 mg/l) compared with when they were seen in outpatient follow-up and less symptomatic (10.3 ± 2.9 mm/h and 0.3 ± 0.1 mg/l; P = 0.0001 and P = 0.211, respectively). Conclusions: Poor glycemic control, infection, noncompliance with/intolerance of medications, and, perhaps, adrenal insufficiency were contributory factors leading to hospitalizations of gastroparetic patients. Hospitalized patients with gastroparesis exacerbations had elevated ESR and CRP levels. Although many patients with elevated inflammatory markers had evidence of infection, some did not. Assessment of inflammatory markers may help indicate those gastroparetic patients in whom a search for infection should be undertaken.
AB - Background: The clinical course of patients with gastroparesis is characterized by symptomatic exacerbations often necessitating hospitalization. Aims: To investigate precipitating factors leading to hospitalization for exacerbation of symptoms in patients with gastroparesis. Methods: This was a retrospective review of 103 admissions (63 patients) for gastroparesis exacerbation. Results: Etiologic categories for gastroparetic patients were diabetic (43%), idiopathic (39%), and post surgical (8%). Poor glycemic control was present in 36%, infection in 19% (12 urinary tract infections and two bacteremia), and noncompliance with or intolerance of, medications in six and 5% of patients, respectively. Fasting morning cortisol concentrations were <3 mcg/dl in 9%. Elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were seen in 34 of 65 (52%) and 11 of 50 patients (22%), respectively. No identifiable infection was found in 74 and 45% of patients with elevated ESR and elevated CRP, respectively. ESR and CRP were higher when patients were symptomatic necessitating hospitalization (26.2 ± 6.6 mm/h and 1.6 ± 1.0 mg/l) compared with when they were seen in outpatient follow-up and less symptomatic (10.3 ± 2.9 mm/h and 0.3 ± 0.1 mg/l; P = 0.0001 and P = 0.211, respectively). Conclusions: Poor glycemic control, infection, noncompliance with/intolerance of medications, and, perhaps, adrenal insufficiency were contributory factors leading to hospitalizations of gastroparetic patients. Hospitalized patients with gastroparesis exacerbations had elevated ESR and CRP levels. Although many patients with elevated inflammatory markers had evidence of infection, some did not. Assessment of inflammatory markers may help indicate those gastroparetic patients in whom a search for infection should be undertaken.
KW - Gastroparesis
KW - Inflammation
KW - Nausea
KW - Vomiting
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U2 - 10.1007/s10620-009-0975-1
DO - 10.1007/s10620-009-0975-1
M3 - Article
C2 - 19760157
AN - SCOPUS:70350228496
SN - 0163-2116
VL - 54
SP - 2404
EP - 2409
JO - Digestive Diseases and Sciences
JF - Digestive Diseases and Sciences
IS - 11
ER -