A0681 - Characterizing Abdominal Pain in Patients With Gastroparesis

Dylan Vainer, MD¹, Dariush Shahsavari, MD², Henry P. Parkman, MD^3
1VCU Health System, Henrico, VA; ²Medical College of Georgia - Augusta University, Augusta, GA; ³Temple University Health System, Philadelphia, PA

Introduction: Patients with gastroparesis (Gp) present with nausea, vomiting, and early satiety. Abdominal pain can be present in Gp. The cause of pain in patients with Gp is unknown. In patients whose main symptom is abdominal pain, other etiologies should be sought. Chronic pancreatitis and acute porphyria are potential causes.

Methods: Patients with Gp diagnosed by gastric emptying studies completed Patient Assessment of Upper GI Symptoms (PAGI-SYM) questionnaire to assess symptoms. Patients reporting abdominal pain also answered questions to assess pain characteristics and underwent testing for serum trypsin, amylase, lipase, urine porphyrins, and urine porphobilinogen.

Results: Of 158 patients with Gp (140 (88.6%) were women, average age 46 ± 16 years, BMI (27 ± 7.0). 86 (54.4%) patients reported abdominal pain as a symptom. The most common locations were periumbilical (38.6%) and left upper quadrant (22.9%). 73.2% of patients with abdominal pain reported constant pain, with the majority (91.5%) having acute exacerbations of pain. The mean severity of constant pain was 2.94 ± 0.93 (scale from 0 = none to 4 = very severe), whereas the severity during acute exacerbations was 3.07 ± 0.82. 48.7% of patients reported radiation of pain, most commonly to the back (86%). Abdominal pain was most frequently exacerbated by eating (78.2%) and improved with pain medications (53.9%) and rest (52.6%). There was no difference in the prevalence of abdominal pain between DM and non-DM patients (43(53%) vs 107(56%); p = 0.807). DM and non-DM patients reported similar abdominal pain severity (chronic pain: 3.13 vs 2.89; p = 0.78, acute pain: 3.06 ± 0.87 vs 3.00 ± 0.80; p = 0.81). One patient with abdominal pain had an elevation in urine porphyrins (227.1 mg/L) and one had elevated urine PBG (4.1 mg/L). None of 45 (0%) patients with abdominal pain had low trypsin levels (< 30 mg/L). No correlation was found between serum trypsin and pain severity (r = 0.114; p = 0.457).

Discussion: Abdominal pain was present in 54% of patients with Gp and characterized by constant pain with intermittent exacerbations. The pain was frequently exacerbated by eating and relieved by pain medications/rest. There were no significant differences in pain severity between DM and non-DM patients. Abnormal pancreatic enzyme and urine porphyrin levels were uncommon among Gp patients with abdominal pain and not correlated with symptom severity. Thus, abdominal pain is frequent in patients with gastroparesis but the cause remains largely unknown.


Disclosures:


Dylan Vainer, MD¹, Dariush Shahsavari, MD², Henry P. Parkman, MD³. A0681 - Characterizing Abdominal Pain in Patients With Gastroparesis, ACG 2022 Annual Scientific Meeting Abstracts. Charlotte, NC: American College of Gastroenterology.