University of Pittsburgh Medical Center, Department of Medicine and Division of Gastroenterology, Pittsburgh, PA 15213, USA.
J Gastroenterol Hepatol. 2011 Aug;26(8):1275-82. doi: 10.1111/j.1440-1746.2011.06735.x.
Gastroparesis significantly impairs the quality of life in affected individuals and may lead to repeat hospitalizations due to refractory symptoms. We hypothesized that pain is a key reason for emergency encounters and diagnostic testing.
Using the ICD9 code 536.3, electronic medical records were analyzed retrospectively. Multivariate regression was used to determine predictors of hospital stays and use of diagnostic testing.
In total, 326 patients (80% women, age: 44.1 ± 0.8 years) were identified. During 504 patient-years of follow up, patients were hospitalized on average slightly more than once annually for about 8 days and underwent 320 endoscopies, 366 computed tomography scans, 390 abdominal X-rays, 90 upper gastrointestinal contrast studies and 163 gastric emptying studies; 37 patients exceeded an annual radiation exposure of 20 mSv at least once. The majority of tests were confirmatory, with results not altering treatment. Vomiting and pain were the most common cause for emergency encounters and diagnostic testing. Age and comorbidity, but not opioid use (present in 25%) or the presence of chronic pain disorders (present in 32%) correlated with increased hospital days.
While surrogate markers of pain do not predict repeat hospitalizations, pain was the primary reason for emergency encounters and frequent diagnostic testing. Repeated testing had a limited impact on treatment and outcome, but certainly contributes to the cost and even risk of care. Concerted efforts are needed to not only improve the care and quality of life of patients with gastroparesis, but also to reduce the number of potentially unnecessary or even harmful interventions.
胃轻瘫显著降低患者的生活质量，并可能导致因难治性症状而反复住院。我们假设疼痛是急诊就诊和诊断性检查的主要原因。
使用 ICD9 编码 536.3，回顾性分析电子病历。采用多变量回归分析确定住院时间和诊断性检查的预测因素。
共纳入 326 例患者（80%为女性，年龄：44.1±0.8 岁）。在 504 例患者年的随访期间，患者平均每年住院略多于 1 次，住院时间约为 8 天，共进行 320 次内镜检查、366 次 CT 扫描、390 次腹部 X 线检查、90 次上消化道造影检查和 163 次胃排空检查；37 例患者的年辐射暴露量至少超过 20 mSv 一次。大多数检查为确诊性检查，检查结果并未改变治疗方案。呕吐和疼痛是急诊就诊和诊断性检查的最常见原因。年龄和合并症，但不是阿片类药物使用（25%的患者使用）或慢性疼痛障碍（32%的患者存在）与住院天数增加相关。
尽管疼痛的替代标志物不能预测再次住院，但疼痛是急诊就诊和频繁进行诊断性检查的主要原因。反复检查对治疗和结局的影响有限，但肯定会增加医疗成本，甚至增加医疗风险。需要共同努力，不仅要改善胃轻瘫患者的护理和生活质量，还要减少潜在的不必要甚至有害的干预措施。
