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Outcomes and Factors Associated With Reduced Symptoms in Patients With Gastroparesis
Open accessAbstract
Background & aims Gastroparesis is a chronic clinical syndrome characterized by delayed gastric emptying. However, little is known about patient outcomes or factors associated with reduction of symptoms. Methods We studied adult patients with gastroparesis (of diabetic or idiopathic type) enrolled in the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium Gastroparesis Registry, seen every 16 weeks and treated according to the standard of care with prescribed medications or other therapies at 7 tertiary care centers. Characteristics associated with reduced symptoms, based on a decrease of 1 or more in the gastroparesis cardinal symptom index (GCSI) score after 48 weeks of care, were determined from logistic regression models. Data were collected from patients for up to 4 years (median, 2.1 y). Results Of 262 patients, 28% had reductions in GCSI scores of 1 or more at 48 weeks. However, there were no significant reductions in GCSI score from weeks 48 through 192. Factors independently associated with reduced symptoms at 48 weeks included male sex, age 50 years and older, initial infectious prodrome, antidepressant use, and 4-hour gastric retention greater than 20%. Factors associated with no reduction in symptoms included overweight or obesity, a history of smoking, use of pain modulators, moderate to severe abdominal pain, a severe gastroesophageal reflex, and moderate to severe depression. Conclusions Over a median follow-up period of 2.1 years, 28% of patients treated for gastroparesis at centers of expertise had reductions in GCSI scores of 1 or greater, regardless of diabetes. These findings indicate the chronic nature of gastroparesis. We identified factors associated with reduced symptoms that might be used to guide treatment. ClinicalTrials.gov no: NCT00398801.
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“Moreover, changes in symptom intensity do not always parallel objective GE measurements, highlighting the complex interplay between pathophysiological derangements and central processing of visceral signals [14, 21–23].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [21]
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Self-citationFebo‐Rodriguez, L., Chumpitazi, B. P., Musaad, S. M. A., Sher, A. C., & Shulman, R. J. (2020) · The Journal of Pediatrics · doi:10.1016/j.jpeds.2020.12.048 · Cited by 8
A global bibliometric and visualized analysis of the status and trends of gastroparesis research
Li, M., Gao, N., Wang, S.-L., Guo, Y., & Liu, Z. (2023) · European journal of medical research · doi:10.1186/s40001-023-01537-1 · Cited by 7
“Medication is often slow to take effect, with one-third of patients showing no improvement until 1 year after the intervention [81].”
BackgroundThe role of diet in diabetes gastroparesis treatment: a systematic review and meta-analysis
Lin, D., Wang, H., Ou, Y., Li, L., Zhang, Q., Yan, J., Peng, D., & Peng, S. (2024) · Frontiers in Endocrinology · doi:10.3389/fendo.2024.1379398 · Cited by 7
Gastroparesis: Time for a Reappraisal?
Tack, J. F., & Wald, A. M. (2015) · Gastroenterology · doi:10.1053/j.gastro.2015.10.029 · Cited by 7
“Paradoxically, more severely delayed gastric emptying was associated with a greater likelihood of improvement, but there were no differences in outcome between diabetic or idiopathic gastroparesis patients at 48 weeks.(14) The finding that patients with coexisting depression, anxiety (as a proxy for anxiolytic use), a…”
BackgroundInfluentialPost-pancreatitis diabetes mellitus: towards understanding the role of gastrointestinal motility
Gold-Smith, F. D., Chand, S. K., & Petrov, M. S. (2018) · Minerva Gastroenterologica e Dietologica · doi:10.23736/s1121-421x.18.02507-2 · Cited by 7
Diabetic Gastroparesis and its Emerging Therapeutic Options: A Narrative Review of the Literature
Zahid, S. A., Tated, R. C. P., Mathew, M., Rajkumar, D., Karnik, S. B., Roy, A. P., Jacob, F. P., Salian, R. B., Razzaq, W., Shivakumar, D., et al. (2023) · Cureus · doi:10.7759/cureus.44870 · Cited by 8
Endoscopic findings do not predict per-oral pyloromyotomy (POP) response
Schwalbe, K., Finelli, C., Moon, S., Niehaus, H., Kondajji, A., Tu, C., Fathalizadeh, A., Kroh, M., & Allemang, M. T. (2022) · Surgical Endoscopy · doi:10.1007/s00464-022-09321-8 · Cited by 6
Wolfson, S. M., Wilhelm, Z. R., Opekun, A. R., Orth, R. C., Shulman, R. J., & Chumpitazi, B. P. (2021) · Journal of Pediatric Gastroenterology and Nutrition · doi:10.1097/mpg.0000000000003089 · Cited by 7
“3% with complete symptom resolution) appears to be better than that in adults followed at quaternary care centers, in which only 28% of adults showed any sign of symptomatic improvement (32).”
BackgroundPatient factors influence surgical options in gastroparesis
Thompson, J. S., Hewlett, A. T., Lyden, E. R., Scott, J. R., & McBride, C. L. (2020) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2020.02.022 · Cited by 6
Therapies for diabetic gastroparesis
Wang, S., Wang, R., Zhang, Y., Zhang, X., Cai, B., Lu, Y., Xia, Y., & Chen, Q. (2020) · Medicine · doi:10.1097/md.0000000000020461 · Cited by 6
Opioids in Gastroparesis: Bystander or Cause?
Pannemans, J., Carbone, F., & Tack, J. F. (2019) · Clinical Gastroenterology and Hepatology · doi:10.1016/j.cgh.2019.08.040 · Cited by 6
Takakura, W., Surjanhata, B. C., Nguyen, L. A. B., Parkman, H. P., Rao, S. S. C., McCallum, R. W., Schulman, M. I., Wo, J. M., Sarosiek, I., Moshiree, B., et al. (2024) · Clinical and Translational Gastroenterology · doi:10.14309/ctg.0000000000000743 · Cited by 5
“Although Pasricha et al. employed cross-validation to estimate performance of their predictive model, the lack of an independent validation data set may have over-estimated their model performance (34).”
InfluentialSelf-citationGlass half empty? Lessons learned about gastroparesis
McKenzie, P., & Bielefeldt, K. (2018) · F1000Research · doi:10.12688/f1000research.14043.1 · Cited by 5
Saleem, S., Hussain, A., Alsamman, M. A., Inayat, F., Kaler, J., Tansel, A., & Thomas, A. L. (2021) · Saudi Journal of Gastroenterology · doi:10.4103/sjg.sjg_673_20 · Cited by 5
The goals for successful development of treatment in gastroparesis
Yang, D. Y., & Camilleri, M. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14849 · Cited by 5
Toward a Better Drug for Gastroparesis: The Problem With a Moving Target
Pasricha, P. J., & Snape, W. J. (2016) · Gastroenterology · doi:10.1053/j.gastro.2016.05.019 · Cited by 5
“1 Gastroparesis, a disorder defined by delayed gastric emptying, and characterized by nausea, vomiting and other chronic debilitating symptoms that improves little over time, remains one of the most challenging gastroenterological conditions to treat.(1) With increasing recognition of the size of the market and the la…”
BackgroundSelf-citationSilva, L. G. R., Cunha, D. N., Ferreira, I. N., Vargas, J. R., Lopes, J. R., Saraiva, N. B., Campos, V. D. A. R., Thomaz, Y. B., & Leite, N. A. A. (2022) · Brazilian Journal of Health Review · doi:10.34119/bjhrv5n2-348 · Cited by 4
Direct Stimulation of Gastric Smooth Muscle Cells via Gq Proteins With Light
Zipf, D., Vogt, M., Sathyanarayanan, U., Wagdi, A., Riebeling, J., Patejdl, R., & Bruegmann, T. (2025) · Neurogastroenterology & Motility · doi:10.1111/nmo.70028 · Cited by 3
Nausea and Vomiting Related to Esophagus and Stomach Diseases
Koch, K. L. (2016) · Springer eBooks · doi:10.1007/978-3-319-34076-0_3 · Cited by 4
Self-citationDurcan, R., Donaghy, P. C., Barnett, N. A., Olsen, K., Yarnall, A. J., Taylor, J., McKeith, I. G., O'Brien, J. T., & Thomas, A. J. (2019) · International Journal of Geriatric Psychiatry · doi:10.1002/gps.5100 · Cited by 4
“A number of factors have independent of LB disease have been associated with reduced gastroparesis symptoms including; male sex, age greater than 50 years, and concomitant medication use such gastric acid suppressing agents and antidepressant use.(25) We do not believe any of these factors contributed to the low rates…”
BackgroundGender Differences in Gastroparesis
Kassamali, F., & Lin, M. S. (2023) · Foregut The Journal of the American Foregut Society · doi:10.1177/26345161231160723 · Cited by 4
Reconsideration of the Gastroparetic Syndrome
Gilbert, R., Siamwala, J. H., Kumar, V., Thompson, C. C., & Shikora, S. A. (2023) · Current Gastroenterology Reports · doi:10.1007/s11894-023-00865-w · Cited by 4
Rayner, C. K., Jones, K. L., & Horowitz, M. (2020) · Elsevier eBooks · doi:10.1016/b978-0-12-818586-5.00018-1 · Cited by 4
Wifi, M.-N., El-Sherbiny, M., Mohamed, R. S., Kandeel, A., & Rizk, S. E. (2025) · BMC Gastroenterology · doi:10.1186/s12876-025-03977-x · Cited by 3
“This 4 The correlations between Age, HbA1c reduction (%), initial total GCSI and response to medical treatment (≥ 50 years) was associated with the best outcome, with an odds ratio for improvement of 3.35 (CI:1.62–6.91, p = 0.001) [24].”
InfluentialAbraham, R., Foong, D., & Ho, V. (2025) · Journal of Neurogastroenterology and Motility · doi:10.5056/jnm25094 · Cited by 3
“7,9 Our findings further support the idea that while GES provides essential information on emptying, it is often insufficient on its own to fully inform clinical management.”
InfluentialWang, X. J., O'Connor, M. C., Peck, T., Johnston, G., & Prichard, D. O. (2024) · Neurogastroenterology & Motility · doi:10.1111/nmo.14819 · Cited by 3
“4,39 Indeed, many patients with upper gastrointestinal symptoms have dysfunction of multiple sensorimotor facets.”
Clinical predictors of symptom improvement failure in gastroparesis
Amjad, W. (2022) · Annals of Gastroenterology · doi:10.20524/aog.2022.0696 · Cited by 4
“Our study was unable to reproduce the predictors of a poor outcome, including obesity, smoking and depression, established by a previous prospective large multicenter study over a longer period [5].”
ResultTrends in Gastroparesis Management
Tanner, S. E., Kurin, M., Shahsavari, D., Malik, Z. A., & Parkman, H. P. (2022) · Journal of Clinical Gastroenterology · doi:10.1097/mcg.0000000000001766 · Cited by 3
Self-citationGastroparesis for the nongastroenterologist
Araujo‐Duran, J., Chatterjee, A., & Garg, S. (2024) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.91a.23078 · Cited by 3
“18,19 Gastroparesis is associated with increased emergency department visits and hospitalizations due to exacerbation of symptoms such as vomiting, electrolyte abnormalities, abdominal pain, and malnutrition.”
BackgroundChartier, M., Duboc, H., Moszkowicz, D., Dior, M., Gall, M. L., Coffin, B., & Soliman, H. (2024) · Clinics and Research in Hepatology and Gastroenterology · doi:10.1016/j.clinre.2024.102481 · Cited by 3
Targeting Treatment of Gastroparesis
Hasler, W. L. (2020) · Gastroenterology Clinics of North America · doi:10.1016/j.gtc.2020.04.007 · Cited by 3
Self-citation
Metadata
- Authors
- Pasricha, P. J., Yates, K. P., Nguyen, L., Clarke, J., Abell, T. L., Farrugia, G., Hasler, W. L., Koch, K. L., Snape, W. J., McCallum, R. W., Sarosiek, I., Tonascia, J., Miriel, L. A., Lee, L., Hamilton, F., & Parkman, H. P.
- Affiliations
- Johns Hopkins University (US)
- Stanford University (US)
- University of Louisville (US)
- Mayo Clinic (US)
- University of Michigan (US)
- Wake Forest University Health Sciences (US)
- California Pacific Medical Center (US)
- Texas Tech University (US)
- National Institute of Diabetes and Digestive and Kidney Diseases (US)
- Temple University (US)
- Corresponding author
- Pasricha, Pankaj J.
- ORCID
- Venue
- Gastroenterology
- Publisher
- Elsevier BV
- Published
- 2015-12
- Volume
- 149
- Issue
- 7
- Pages
- 1762-1774.e4
- ISSN
- 0016-5085 (ISSN-L)
- PMC
- PMC4663150
- OpenAlex
- W1188512702
- Cited by
- 143
- References
- 60
- Citations by year
- 2026: 12 · 2025: 7 · 2024: 13 · 2023: 13 · 2022: 12 · 2021: 13 · 2020: 18 · 2019: 18 · 2018: 14 · 2017: 9 · 2016: 11 · 2015: 3
- FWCI
- 11.69
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Gastroenterology (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- Funders
- Association of Schools of Public Health (2007-2010, 2009-2011, 2009-2012)
- Johns Hopkins University
- National Institute of Diabetes and Digestive and Kidney Diseases
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Keywords
- gastroparesis, delayed gastric emptying, symptom improvement, Gastroparesis Cardinal Symptom Index, diabetic gastroparesis, idiopathic gastroparesis, gastric retention, abdominal pain, depression, obesity, smoking, antidepressants, gastroesophageal reflux, treatment outcomes
- MeSH terms
- Adult, Age Factors, Female, Gastric Emptying, Humans, Life Style, Male, Middle Aged, Predictive Value of Tests, Registries, Remission Induction, Risk Factors, Severity of Illness Index, Sex Factors, Time Factors, United States, Comorbidity, Linear Models, Logistic Models, Odds Ratio, Treatment Outcome, Gastroparesis, Recovery of Function
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