Ethnic, Racial, and Sex Differences in Etiology, Symptoms, Treatment, and Symptom Outcomes of Patients With Gastroparesis.

BACKGROUND & AIMS: Gastroparesis is a chronic disorder of the stomach characterized by nausea, vomiting, early satiety, postprandial fullness, and abdominal pain. There is limited information on gastroparesis in minority populations. We assessed ethnic, racial, and sex variations in the etiology, symptoms, quality of life, gastric emptying, treatments, and symptom outcomes of patients with gastroparesis. METHODS: We collected information from the National Institutes of Health Gastroparesis Consortium on 718 adult patients, from September 2007 through December 2017. Patients were followed every 4 or 6 months, when data were collected on medical histories, symptoms (based on answers to the PAGI-SYM questionnaires), and quality of life (based on SF-36). Follow-up information collected at 1 year (48 week) was used in this analysis. Comparisons were made between patients of self-reported non-Hispanic white, non-Hispanic black, and Hispanic ethnicities, as well as and between male and female patients. RESULTS: Our final analysis included 552 non-Hispanic whites (77%), 83 persons of Hispanic ethnicity (12%), 62 non-Hispanic blacks (9%), 603 women (84%), and 115 men (16%). A significantly higher proportion of non-Hispanic blacks (60%) had gastroparesis of diabetic etiology than of non-Hispanic whites (28%); non-Hispanic blacks also had more severe retching (2.5 vs 1.7 score) and vomiting (2.9 vs 1.8 score) and a higher percentage were hospitalized in the past year (66% vs 38%). A significantly higher proportion of Hispanics had gastroparesis of diabetic etiology (59%) than non-Hispanic whites (28%), but Hispanics had less-severe nausea (2.7 vs 3.3 score), less early satiety (3.0 vs 3.5 score), and a lower proportion used domperidone (8% vs 21%) or had a peripherally inserted central catheter (1% vs 7%). A higher proportion of women had gastroparesis of idiopathic etiology (69%) than men (46%); women had more severe symptoms of stomach fullness (3.6 vs 3.1 score), early satiety (3.5 vs 2.9 score), postprandial fullness (3.7 vs 3.1 score), bloating (3.3 vs 2.6 score), stomach visibly larger (3.0 vs 2.1 score), and upper abdominal pain (2.9 vs 2.4 score). A lower proportion of women were hospitalized in past year (39% vs 53% of men). CONCLUSIONS: In patients with gastroparesis, etiologies, symptom severity, and treatments vary among races and ethnicities and between sexes. ClinicalTrials.gov Identifier: NCT01696747.

The influence of race on symptom severity and quality of life in gastroparesis.

BACKGROUND: The majority of clinical studies for gastroparesis have primarily included white women. Our aim was to compare the etiology, clinical characteristics, healthcare utilization, symptom profile, and quality of life (QOL) in white and nonwhite patients with gastroparesis. METHODS: Newly referred patients with gastroparesis completed: (1) a comprehensive demographic profile, (2) the Patient Assessment of Upper Gastrointestinal Disorder Symptoms (PAGI-SYM), and (3) the Patient Assessment of Upper Gastrointestinal Disorders QOL (PAGI-QOL). All patients had confirmed delayed gastric emptying as measured by 4-hour scintigraphy. RESULTS: A total of 255 patients were enrolled; mean age was 42.5 years and 83.3% were females. There were 44 (17%) nonwhites (33 African American and 11 Hispanic) and 211 (83%) whites. The proportion of nonwhite patients with gastroparesis secondary to diabetes was 55% compared with 19% of white patients (P<0.001). The total PAGI-SYM score was higher in nonwhite patients. Nonwhite patients had higher PAGI-SYM subscale scores for nausea/vomiting, upper abdominal pain, and lower abdominal pain. The 2 groups differed in health care utilization: 49% of nonwhite patients reported ≥4 gastroparesis-related emergency department visits and 42% reported more ≥4 gastroparesis-related hospitalizations, as compared with 20% and 14% of white patients, respectively. Total PAGI-QOL scores were lower in nonwhite patients. Linear regression showed that nonwhite race, sex, age, and age of onset were independently associated with symptom scores, whereas etiology of gastroparesis and gastric emptying times were not. CONCLUSIONS: Nonwhite patients with gastroparesis had more severe symptoms, poorer QOL, and utilized more health care resources than white. Nonwhites were more likely to have diabetes as the etiology.