National survey of physicians' perception of the cause, complications, and management of gastroparesis.

OBJECTIVES: Manifestations of gastroparesis are heterogeneous and clinical complications are poorly defined. Misconceptions of gastroparesis may be common. The objective was to determine physicians' perception of gastroparesis and identify areas that need further research and education. METHODS: A physician survey was prospectively developed and tested. The survey included questions on the etiology, symptoms, management and perceived complications of gastroparesis. Physicians' feedback included rated responses by Likert scale and ranked responses by priority. A total of 3658 surveys were mailed to gastroenterologists and general practitioners using an online physician directory and a local medical society directory. Analysis of variance and t test were utilized. RESULTS: A total of 397 surveys were returned. 85.9% of responses were from the national survey and 14.1% were local. Physicians ranked diabetes (70%) as the most common cause of gastroparesis, followed by idiopathic (21%) and postsurgical (9%). Postprandial epigastric pain (61%) was ranked as the most frequent symptom of gastroparesis, followed by retching/vomiting (20%) and heartburn/regurgitation (19%). 60% believed scintigraphy t1/2 is an accurate measurement of gastric emptying. Only one-third believed gastric electrical stimulation was effective as treatment of gastroparesis. Physicians rated abdominal pain as the most clinically significant complication of gastroparesis surpassing weight loss, hospitalization for dehydration, and malnutrition (P < 0.01). There were small but statistically significant differences between gastroenterologists versus general practitioners and private versus academic physicians. CONCLUSION: More physician awareness and education is needed on gastroparesis and the standardized four-hour gastric scintigraphy method, as well to clarify the management strategy for this condition.

A novel classification scheme for gastroparesis based on predominant-symptom presentation.

AIM: Symptoms of gastroparesis are very diverse. Classifying patients by predominant symptom may improve management strategy. GOAL: To validate a new symptom-predominant classification for gastroparesis using symptom severity and quality-of-life measures. STUDY: Subjects with gastroparesis for >2 months were prospectively enrolled. A physician classified each subject into one of the following: vomiting-predominant, dyspepsia-predominant, or regurgitation-predominant gastroparesis. Subjects also classified themselves independently from the physician. Each subject completed a Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) and SF-12v2 Health-Related Quality-Of-Life survey. Receiver operating characteristic curves were constructed with sensitivity and specificity of each PAGI-SYM subscale to differentiate subjects into symptom-predominant subgroups. Area under the curve (AUC) was used to compare the receiver operating characteristic curves. Analysis of variance, Cohen's kappa (kappa) statistic, student t test, and Pearson correlation (r) were used. RESULTS: One hundred subjects (87 females, mean 48 y) were enrolled. There was a 78% concordance between physician and subject's classification of gastroparesis with substantial correlation (kappa=0.64). PAGI-SYM nausea/vomiting subscale (AUC=0.79) and PAGI-SYM heartburn/regurgitation subscale (AUC=0.73) were the best in differentiating subjects into vomiting-predominant and regurgitation-predominant gastroparesis, respectively. No subscale was adequate to differentiate dyspepsia-predominant gastroparesis. SF-12v2 total scores significantly correlated with worsening of the total PAGI-SYM scores (r=-0.339 to -0.600, all P<0.001). CONCLUSIONS: There was a substantial agreement between physician and patient using a symptom-predominant gastroparesis classification. Results suggest that a predominant-symptom classification is a valid means to categorize subjects with vomiting-predominant and regurgitation-predominant gastroparesis. Patients with dyspepsia and delayed gastric emptying need further research.