频繁前往急诊科就诊和住院的胃轻瘫症状患者的特征分析。
Characterization of Patients With Symptoms of Gastroparesis Having Frequent Emergency Department Visits and Hospitalizations.
作者信息
Parkman Henry P, Xin Yuchen, Wilson Laura A, Burton-Murray Helen, McCallum Richard W, Sarosiek Irene, Moshiree Baha, Koch Kenneth L, Bulat Robert S, Grover Madhusudan, Farrugia Gianrico, Chumpitazi Bruno P, Shulman Robert J, Miriel Laura A, Tonascia James, Pasricha Pankaj J, Kuo Braden, Abell Thomas L
机构信息
Temple University, Philadelphia, Pennsylvania.
Johns Hopkins University, Baltimore, Maryland.
出版信息
Clin Gastroenterol Hepatol. 2025 Apr 24. doi: 10.1016/j.cgh.2025.01.033.
BACKGROUND & AIMS: Patients with gastroparesis (Gp) can be high users of the medical system. In this study, we characterized patients with Gp symptoms who had frequent emergency department (ED) visits and hospitalizations.
METHODS
Patients with symptoms of Gp underwent history and physical examination, gastric emptying scintigraphy (GES), and questionnaires capturing number of ED visits and hospitalizations over the prior year, GI symptoms (Patient Assessment of Upper GI Symptoms [PAGI-SYM]), anxiety and depression [Hospital Anxiety and Depression Scale (HADS)], somatization [Patient Health Questionnaire (PHQ-15)], and quality of life (SF-36v2 and Patient Assessment of Upper GastroIntestinal Disorders-Quality of Life [PAGI-QOL]).
RESULTS
Of 406 patients with symptoms of Gp (294; 72.4%) had delayed gastric emptying (33% diabetic, 61% idiopathic, 6% postfundoplication), 159 patients (39%) had prior ED visits. Baseline characteristics that were independently associated with ED visits over the prior year included younger age, Black race, lower income, higher gastric retention on GES at 4 hours, antiemetic medication use, cannabis use, jejunostomy tube presence, and higher nausea/vomiting scores. Ninety-two patients (23%) had hospitalizations due to symptoms of Gp over the prior year. The most frequent reasons for hospitalizations included nausea (83%), vomiting (78%), abdominal pain (70%), and dehydration (59%). Baseline characteristics that were independently associated with increased hospitalizations were younger age, Black race, lower income, diabetic etiology, greater 4-hour gastric retention, prokinetic use, cannabis use, jejunostomy tube presence, higher nausea/vomiting scores, and higher depression scores.
CONCLUSIONS
Our study of patients with symptoms of Gp revealed a sizeable subset have had Gp-related ED visits and hospitalizations over the past year. Several factors related to etiology, GE delay, GI symptom severity, depression severity, race, and lower income were associated with ED visits and hospitalizations.
CLINICALTRIALS
gov Identifier: N3CT01696747.
背景与目的
胃轻瘫（Gp）患者可能是医疗系统的高使用人群。在本研究中，我们对有频繁急诊就诊和住院史的Gp症状患者进行了特征分析。
方法
有Gp症状的患者接受了病史采集、体格检查、胃排空闪烁扫描（GES），并填写问卷，记录上一年的急诊就诊次数和住院次数、胃肠道症状（上消化道症状患者评估量表[PAGI-SYM]）、焦虑和抑郁（医院焦虑抑郁量表[HADS]）、躯体化症状（患者健康问卷[PHQ-15]）以及生活质量（SF-36v2和上消化道疾病患者生活质量评估量表[PAGI-QOL]）。
结果
406例有Gp症状的患者中，294例（72.4%）胃排空延迟（33%为糖尿病性，61%为特发性，6%为胃底折叠术后），159例（39%）有过急诊就诊史。与上一年急诊就诊独立相关的基线特征包括年龄较小、黑人种族、收入较低、4小时时GES检查显示胃潴留较高、使用止吐药、使用大麻、存在空肠造口管以及恶心/呕吐评分较高。92例（23%）患者上一年因Gp症状住院。住院的最常见原因包括恶心（83%）、呕吐（78%）、腹痛（70%）和脱水（59%）。与住院次数增加独立相关的基线特征包括年龄较小、黑人种族、收入较低、糖尿病病因、4小时胃潴留更严重、使用促动力药、使用大麻、存在空肠造口管、恶心/呕吐评分较高以及抑郁评分较高。
结论
我们对有Gp症状患者的研究表明，在过去一年中，有相当一部分患者因Gp相关原因进行了急诊就诊和住院治疗。与病因、胃排空延迟、胃肠道症状严重程度、抑郁严重程度、种族和低收入相关的几个因素与急诊就诊和住院治疗有关。
临床试验
美国国立医学图书馆临床试验标识符：N3CT01696747。
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