Clinical predictors of symptom improvement failure in gastroparesis.

Background: The aim of this study was to determine clinical predictors of gastroparesis outcomes. Methods: Between September 30, 2009 and January 31, 2020, we identified patients with gastroparesis diagnosed based on a 99mTc sulfur-labeled gastric emptying test. The patients who had no symptom improvement at 4 and 12 weeks were considered to have failed to show clinical improvement. Logistic regression was used to compute the association between different factors and clinical outcomes. Results: We identified 320 patients (mean age 47.5±5.3 years, 70.3% female, 71.3% Whites). Failure of clinical improvement was seen in 34.7% patients at 4 weeks and 27.5% at 12 weeks after the gastroparesis diagnosis. At 4 weeks, chronic kidney disease (adjusted odds ratio [aOR] 2.62, 95% confidence interval [CI] 1.31-5.26; P=0.007) and body mass index (BMI) <18.5 kg/m2 (aOR 9.90, 95%CI 2.98-32.93; P<0.001) were associated with a lack of improvement, whereas type 2 diabetes mellitus (T2DM) was associated with better clinical outcomes (aOR 0.50, 95%CI 0.25-0.99; P=0.047). At 12 weeks, subjects who had undergone post-bariatric surgery had no improvement of their gastroparesis symptoms (aOR 2.43, 95%CI 1.01-5.82; P=0.047), whereas T2DM was associated with clinical improvement (aOR 0.46, 95%CI 0.22-0.95; P=0.035). The subgroup analysis showed that BMI <18.5 kg/m2 in non-diabetics and peripheral neuropathy in diabetics were associated with persistent symptoms. Conclusions: Gastroparesis patients with T2DM had significant symptom improvement. A history of bariatric surgery and renal failure were associated with worse clinical improvement. Peripheral neuropathy in diabetics was associated with persistent symptoms.

Cardiac Tamponade as the Initial Presentation of Metastatic Esophageal Adenocarcinoma.

Malignancy accounts for approximately 15-20% of moderate to large pericardial effusions. Pulmonary and colon are the most common primary causes. Large pleural effusions tend to present with a less dramatic clinical picture. It is because fluids tend to build up slowly, giving enough time to the pericardial sac to accommodate it until pressure reaches a critical value causing right heart chambers to collapse. In this report, we present the case of a 51-year-old male with cardiac tamponade as the first manifestation of esophageal adenocarcinoma. The patient presented with shortness of breath and pleuritic chest pain for one week, with no other associated symptoms. Early workup indicated a cardiac tamponade likely secondary to lung malignancy. Further workup demonstrated that the primary source was an esophageal malignancy. In this setting, pericardial effusions are usually related to radiation/chemotherapy, but in rare cases, cardiac tamponade can be the first manifestation of esophageal cancer.