Characteristics and outcomes of patients with gastroparesis using enteral and/or exclusive parenteral nutrition

Authors: PARKMAN, HENRY - Temple University; BLACKFORD, AMANDA - Johns Hopkins University; MURRAY, HELEN - Harvard Medical School; YATES, KATHERINE - Johns Hopkins University; GROVER, MADHUSUDAN - Mayo Clinic; MALIK, ZUBAIR - Temple University; SCHEY, RON - Temple University; BULAT, ROBERT - Johns Hopkins University; KOCH, KENNETH - Wake Forest University; SAROSIEK, IRENE - Texas Tech University Health Science Center; KUO, BRADEN - Harvard Medical School; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); CHUMPITAZI, BRUNO - Children'S Nutrition Research Center (CNRC); FARRUGIA, GIANRICO - Mayo Clinic; MIRIEL, LAURA - Johns Hopkins University; TONASCIA, JAMES - Johns Hopkins University; HAMILTON, FRANK - National Institutes Of Health (NIH); PASRICHA, PANKAJ - Johns Hopkins University; MCCALLUM, RICHARD - Texas Tech University Health Science Center; ABELL, THOMAS - University Of Louisville

Submitted to: Journal of Parenteral and Enteral Nutrition
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/1/2023
Publication Date: 5/1/2023
Citation: Parkman, H.P., Blackford, A.L., Murray, H., Yates, K.P., Grover, M., Malik, Z., Schey, R., Bulat, R.S., Koch, K.L., Sarosiek, I., Kuo, B., Shulman, R.J., Chumpitazi, B.P., Farrugia, G., Miriel, L., Tonascia, J., Hamilton, F., Pasricha, P.J., McCallum, R.W., Abell, T.L. 2023. Characteristics and outcomes of patients with gastroparesis using enteral and/or exclusive parenteral nutrition. Journal of Parenteral and Enteral Nutrition. 47(4):541-549. https://doi.org/10.1002/jpen.2493.
DOI: https://doi.org/10.1002/jpen.2493

Interpretive Summary: Slow stomach emptying (gastroparesis) can cause severe stomach symptoms that often impact the ability to eat and result in poor nutrition. In some cases, the symptoms can be so severe that those affected need to be fed by a tube into their small intestine or receive nutrition through a vein (IV). In this study we found that of 971 adults with slow stomach emptying, a small percentage (3%) were severely affected and needed these types of artificial nutrition. The problem severely impacted their quality of life. The results point to the unmet need to find treatments for this minority of patients who are most affected by slow stomach emptying and that similar studies need to be done in children.

Technical Abstract: Patients with gastroparesis (Gp) may need enteral nutrition (EN) or exclusive parenteral nutrition (PN). Among patients with Gp, we aimed to (1) identify the frequency of EN and exclusive PN use and (2) explore characteristics of patients using EN and/or exclusive PN compared with those using oral nutrition (ON),including changes over 48 weeks. Patients with Gp underwent history and physical examination, gastric emptying scintigraphy, water load satiety testing (WLST), and questionnaires assessing gastrointestinal symptoms and quality of life (QOL). Patients were observed 48 weeks. Of 971 patients with Gp (idiopathic, 579; diabetic, 336; post–Nissen fundoplication, 51), 939 (96.7%) were using ON only, 14 (1.4%) using exclusive PN, and 18 (1.9%) using EN. Compared with patients receiving ON, patients receiving exclusive PN and/or EN were younger, had lower body mass index, and had greater symptom severity. Patients receiving exclusive PN and/or EN had lower physical QOL but not mental QOL or Gp-related QOL scores. Patients receiving exclusive PN and/or EN ingested less water during WLST but did not have worse gastric emptying. Of those who had been receiving exclusive PN and/or EN, 50% and 25%, respectively, resumed ON at 48-week follow-up. This study describes patients with Gp requiring exclusive PN and/or EN for nutrition support, who represent a small (3.3%) but important subset of patients with Gp. Unique clinical and physiological parameters are associated with this subset and provide insight into the use of nutrition support in Gp.