P0988 - Predictors and Outcomes of Protein-Calorie Malnutrition in Gastroparesis

Sunday, October 24, 2021

3:30 PM – 7:00 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Waseem Amjad, MD

Albany Medical Center
Albany, NY, United States

Waseem Amjad, MD¹, Michelle Tram, ², Mirrah Mumtaz, MD¹, Adnan Malik, MD³, Muhammad Shabbir, MD¹, Asha Pandu, MD, MCPS¹, Seth Richter, MD⁴
¹Albany Medical Center, Albany, NY; ²Siena College, Loudonville, NY; ³Loyola University Medical Center, Maywood, IL; ⁴Albany Medical College, Albany, NY

Introduction: Poor oral intake in severe cases of gastroparesis can lead to protein-calorie malnutrition which adds to the disease burden (Neurogastroenterol Motil 2006; 18(4), 263-83). The data about the predictors of malnutrition in gastroparesis patients is scarce. We aim to determine the predictors of malnutrition in diabetic and non-diabetic gastroparesis.

Methods: We performed a retrospective review of patients diagnosed with gastroparesis between September 30th, 2009 and January 31st, 2020. ^99mTc sulfur labeled food was used to diagnose gastroparesis. Patients with protein-calorie malnutrition (PCM) at the time of gastroparesis diagnosis were identified with review of electronic health records. Multivariate analysis after adjusting for confounding variables was done to compute the association of protein-calorie malnutrition predictors.

Results: Of the total 315 patients with gastroparesis, 64 (20.3%) had PCM. The mean age of patients with PCM was 49.7 ± 18.6, 57.8% were female, and 73.4% were white. Multivariate analysis showed that chronic kidney disease (OR: 3.73, 95% CI 1.57-8.87, p=0.003), coronary artery disease (OR: 2.70, 95% CI 1.03-7.06, p=0.04), and neuromuscular disease (OR: 4.03, 95% CI 1.36-11.98, p=0.01) were associated with PCM. The severity of gastroparesis (OR: 1.88, 95% CI 0.95-3.72, p=0.07) modestly predicted the likelihood of PCM. The history of CKD, CAD, and opiate use in diabetics were associated with PCM, whereas history of neuromuscular disease was associated with PCM in non-diabetics. The patients with PCM in gastroparesis had higher mortality (HR 4.94, 95% CI 2.29-10.63, p< 0.001) and refractory gastroparesis disease at week-4 (OR 3.50, 95% CI 1.77-6.91, p< 0.001) and week-12 (OR: 2.04, 95% CI 1.03-4.08, p=0.04) of diagnosis. These outcomes were not affected by the medical treatment of gastroparesis.

Discussion: Patients with gastroparesis and history of chronic kidney disease, coronary artery disease, and/or neuromuscular disease were associated with protein-calorie malnutrition. Additionally, opiate use in diabetics predicted PCM. These patients had higher mortality and poor symptom improvement with or without medical treatment.

Figure: Forest plot showing predictors of malnutrition in gastroparesis.

Baseline characteristics of protein-calorie malnutrition in gastroparesis patients.

Variables	Total cases (n=315)	Present (n=64) N(%age) or mean ± SD	Absent (n=251) N(%age) or mean ± SD	Two group comparisons (p-value)
Demographics
Age	47.32 ± 16.32	49.71 ± 18.59	46.72 ± 15.66	0.24
Female	221 (70.2)	37 (57.8)	184 (73.3)	0.02
White	225 (71.4)	47 (73.4)	178 (79.9)	0.36
Comorbidities
BMI	29.20 ± 8.63	22.51 ± 5.71	30.93 ± 8.42	< 0.001
Hemoglobin A1c (%)	8.3 ± 2.24	8.91 ± 2.62	8.11 ± 2.09	0.12
Obesity	136 (43.2)	9 (14.1)	127 (50.6)	< 0.001
HTN	125 (39.7)	26 (40.6)	99 (39.4)	0.86
T1DM	35 (11.1)	13 (20.3)	22 (8.8)	0.01
T2DM	93 (29.5)	16 (25)	77 (30.7)	0.37
GERD	201 (63.8)	42 (65.6)	159 (63.3)	0.74
CKD	58 (13.4)	24 (37.5)	34 (13.5)	< 0.001
CAD	49 (15.6)	15 (23.4)	34 (13.5)	0.05
COPD	43 (13.7)	9 (14.1)	34 (13.5)	0.91
Autoimmune	33 (10.5)	8 (12.5)	25 (10.0)	0.55
Neuromuscular dx	25 (7.9)	9 (14.1)	16 (6.4)	0.04
Cancer	32 (10.2)	5 (7.8)	27 (10.8)	0.49
Cirrhosis	7 (2.2)	4 (6.3)	3 (1.2)	0.01
Smoking	176 (55.9)	39 (60.9)	137 (54.6)		0.36
Bariatric surgery	29 (9.2)	6 (9.4)	23 (9.2)		0.97
Esophageal surgery	16 (5.1)	6 (9.4)	10 (4.0)		0.08
Medications
PPI	256 (81.3)	54 (84.4)	202 (80.5)		0.51
H2 receptor antagonist	76 (24.1)	13 (20.3)	63 (25.1)		0.42
Opiates	129 (41.0)	29 (45.3)	100 (39.8)		0.43
Antidepressants	191 (60.6)	34 (53.1)	157 (62.5)		0.17
Prokinetics before diagnosis	54 (17.1)	13 (20.3)	41 (16.3)		0.45
Prokinetic after diagnosis	164 (52.1)	40 (62.5)	124 (49.4)		0.06
Benzodiazepines	109 (34.6%)	18 (28.1)	91 (36.3)		0.22

Abbreviations: HTN hypertension; BMI body mass index; T1DM type 1 diabetes mellitus; T2DM type 2 diabetes mellitus; GERD gastroesophageal reflux disease; CKD chronic kidney disease; CAD coronary artery disease; COPD chronic obstructive pulmonary disease; PPI proton pump inhibitor

Table: Baseline characteristics of protein-calorie malnutrition in gastroparesis patients.

Disclosures:

Waseem Amjad indicated no relevant financial relationships.

Michelle Tram indicated no relevant financial relationships.

Mirrah Mumtaz indicated no relevant financial relationships.

Adnan Malik indicated no relevant financial relationships.

Muhammad Shabbir indicated no relevant financial relationships.

Asha Pandu indicated no relevant financial relationships.

Seth Richter indicated no relevant financial relationships.

Waseem Amjad, MD¹, Michelle Tram, ², Mirrah Mumtaz, MD¹, Adnan Malik, MD³, Muhammad Shabbir, MD¹, Asha Pandu, MD, MCPS¹, Seth Richter, MD⁴. P0988 - Predictors and Outcomes of Protein-Calorie Malnutrition in Gastroparesis, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.