B0693 - Differences in Therapeutic Response Among Patients With Atypical Causes of Gastroparesis

Monday, October 24, 2022

10:00 AM – 12:00 PM ET

Location: Crown Ballroom

Presenting Author(s)

Lauren Szeto, MD

Temple University Hospital
Philadelphia, PA

Lauren Szeto, MD¹, Henry P. Parkman, MD²
¹Temple University Hospital, Philadelphia, PA; ²Temple University School of Medicine, Philadelphia, PA

Introduction: Aside from dietary modification, patients with gastroparesis are often prescribed medications to manage their gastrointestinal symptoms. Prokinetic agents as well as endoscopic pyloric botulinum toxin injection are frequently used to treat gastroparesis. Most of these therapies have been previously studied only in idiopathic or diabetic gastroparesis, the most common etiologies of gastroparesis. We aim to describe how symptom response to gastroparesis therapies differs among atypical causes of gastroparesis compared to diabetic and idiopathic causes.

Methods: Gastroparesis patients being evaluated at our institution between 2018 and 2021 completed a questionnaire inquiring about prior gastroparesis therapies tried; particularly metoclopramide, domperidone, erythromycin, and botulinum toxin injection. Patients self-reported whether they had previously tried the therapy, if the therapy improved their symptoms, and whether they experienced any associated side effects. Patients were divided into groups relating to their etiology of gastroparesis: diabetic, postsurgical (PSGp), connective tissue (CTGp), neurologic (NGp) and idiopathic.

Results: A total of 256 patients with gastroparesis completed the questionnaire. Metoclopramide was the therapy most atypical gastroparesis patients had previously tried (PSGp 58.6%, CTGp 69.2%, NGp 60.0%). Atypical gastroparesis patients generally reported poor symptom improvement with both prokinetic agents and botulinum toxin injection (Table 1). Postsurgical (metoclopramide 41.2%, domperidone 57.1%, erythromycin 50.0%) and connective tissue gastroparesis (metoclopramide 33.3%, domperidone 50.0%, erythromycin 66.7%) reported prokinetic-related side effects more frequently than neurologic gastroparesis (metoclopramide 33.3%, domperidone 33.3%, erythromycin 0.0%, p< 0.001). Idiopathic, diabetic, PSGp, and CTGp groups reported no side effects after pyloric botulinum injection.

Discussion: Metoclopramide was the most widely used therapy for patients with atypical gastroparesis. Symptom improvement with prokinetics and botulinum injection was poor among atypical causes of gastroparesis. Side effects associated with domperidone and erythromycin were more frequently noted in patients with PSGp and CTGp patients than NGp. Current treatment options for gastroparesis are limited and options may be further limited for patients with atypical gastroparesis due to associated side effects.

	Metoclopramide	Domperidone	Erythromycin	Botulinum toxin
Idiopathic (n=149)
Previously tried	83 (55.7%)	32 (21.5%)	34 (22.8%)	21 (14.1%)
Symptoms improved	20 (24.1%)	13 (40.6%)	4 (11.8%)	9 (42.9%)
Experienced side effects	40 (48.2)	5 (15.6)	4 (11.8%)	0 (0.0%)

Diabetic (n=60)
Previously tried	42 (70.0%)	14 (23.3%)	11 (18.3%)	14 (23.3%)
Symptoms improved	16 (38.1%)	7 (50.0%)	4 (36.4%)	1 (7.1%)
Experienced side effects	12 (28.6%)	0 (0.0%)	1 (9.1%)	0 (0.0%)

Postsurgical (n=29)
Previously tried	17 (58.6%)	7 (24.1%)	8 (27.6%)	6 (20.7%)
Symptoms improved	3 (17.6%)	2 (28.6%)	2 (25.0%)	2 (33.3%)
Experienced side effects	7 (41.2%)	4 (57.1%)	4 (50.0%)	0 (0.0%)

Connective tissue (n=13)
Previously tried	9 (69.2%)	2 (15.4%)	3 (23.1%)	5 (38.5%)
Symptoms improved	2 (22.2%)	0 (0.0%)	0 (0.0%)	1 (20.0%)
Experienced side effects	3 (33.3%)	1 (50.0%)	2 (66.7%)	0 (0.0%)

Neurologic (n=5)
Previously tried	3 (60.0%)	3 (60.0%)	3 (60.0%)	1 (20.0%)
Symptoms improved	2 (66.7%)	2 (66.7%)	1 (33.3%)	0 (0.0%)
Experienced side effects	1 (33.3%)	1 (33.3%)	0 (0.0%)	1 (100.0%)

Table: Therapeutic response among patients with atypical gastroparesis. Data is represented as number of patients (percentages).

Disclosures:

Lauren Szeto indicated no relevant financial relationships.

Henry Parkman indicated no relevant financial relationships.

Lauren Szeto, MD¹, Henry P. Parkman, MD². B0693 - Differences in Therapeutic Response Among Patients With Atypical Causes of Gastroparesis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.