Delayed Radionucleotide Gastric Emptying Studies Predict Morbidity in Diabetics With Symptoms of Gastroparesis

Received 28 January 2009; accepted 23 April 2009. published online 04 May 2009.

Refers to article:

Continuing Medical Education Exam 1, August 2009 , 24 June 2009
Michael B. Wallace
Gastroenterology
August 2009 (Vol. 137, Issue 2, Pages 724-725)
Full-Text PDF (91 KB)

Background & Aims

The aim of this study was to evaluate the prognostic value of gastric emptying studies on the morbidity associated with diabetic gastroparesis.

Methods

This was a parallel cohort study of 3 groups. Group A (n = 94) contained diabetic patients (type 1 and type 2) with classic symptoms of gastroparesis (including early satiety, postprandial fullness, bloating, abdominal swelling, nausea, vomiting, and retching) and delay in radionucleotide gastric emptying study. Group B (n = 94) contained diabetic subjects with classic symptoms of gastroparesis but negative scintigraphy. Group C (n = 94) contained diabetic subjects without symptoms of gastroparesis. Data were gathered on the number of days hospitalized and hospitalizations, office visits, emergency department visits, death rate, glycosylated hemoglobin levels, medications, and past medical history.

Results

Group A had significantly more hospital days per 1000 patient days (25.5) than both group B (5.1; P < .01) and group C (2.3; P < .01). Group A also had significantly more hospitalizations, office visits, and emergency department visits than both group B and group C. Deaths and mean glycosylated hemoglobin levels did not differ between the groups. Patients in group A were more likely to have cardiovascular disease (19.2% vs 6.4%, A vs C; P < .05), hypertension (63% vs 43%, A vs C; P = .005), and retinopathy (33% vs 11.7%, A vs C; P < .001).

Conclusions

A delayed radionucleotide gastric emptying study predicts negative health outcomes in diabetic patients with symptoms of gastroparesis. We identified a correlation between diabetic gastroparesis and cardiovascular disease, hypertension, and retinopathy that may indicate an underlying vascular etiology.

Abbreviations used in this paper: CAD, coronary artery disease, ED, emergency department, HbA1c, glycosylated hemoglobin

⁎ Division of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts

‡ Division of Gastroenterology, Beth Israel Deaconess Medical Center, Boston, Massachusetts

Reprint requests Address requests for reprints to: Brian Hyett, MD, Division of Gastroenterology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02215. fax: (617) 566-0338

This article has an accompanying continuing medical education activity on page 724. Learning Objective: Upon completion of this exam, successful learners will be able to demonstrate a comprehensive fund of knowledge regarding diabetic gastroparesis.

Conflicts of interest The authors disclose no conflicts.

PII: S0016-5085(09)00720-3

doi:10.1053/j.gastro.2009.04.055

32 of 79