Factors associated with clinically assisted nutrition and healthcare utilisation in patients with delayed gastric emptying labelled with ‘gastroparesis’
Ryan Danvers, Karen McKinnie, Sharon Archbold, Elizabeth Wiseman, Paul Goldsmith, Dipesh H VasantObjective
Gastroparesis is a foregut motility disorder associated with morbidity and impaired quality of life. Effective therapies remain limited, with severe or refractory cases often requiring clinically assisted nutrition (CAN) to prevent malnutrition. We aimed to identify if opioid use, aetiology and hypermobile Ehlers-Danlos syndrome were associated with CAN in patients labelled as ‘gastroparesis’ and quantified the degree of healthcare utilisation associated with these factors.
Design/method
Patients with delayed gastric emptying labelled as ‘gastroparesis’ following gastric emptying scintigraphy were identified from electronic health records. Retrospective data were collected on age, sex, idiopathic/diabetic aetiology, opioid use, body mass index, use of CAN (enteral tubes (ET) or parenteral nutrition (PN)) and annual visits across general practice, outpatient appointments (OP), emergency department visits (ED) and inpatient admissions (IP) between 20202023.
Results
Of 97 patients labelled as gastroparesis, 27/97 received CAN (26 ET; 1 PN) and 42/97 used opioids, with a mean daily morphine dose of 33.2 mg (± SD 41.9). CAN in patients labelled as gastroparesis was associated with opioids (p = 0.0039) and idiopathic aetiology (p=0.03). Compared with oral feeding, CAN was associated with higher annual OP attendances (p=0.0001), ED (p=0.003) and IP (p=0.003). Only 4/27 (14.8%) were de-escalated from CAN over 4 years. Opioid use was associated with more annual attendances across OP (p=0.008), ED (p=0.014) and IP (p=0.013)
Conclusions
CAN is associated with opioid use, higher healthcare burden and long-term dependence in patients with delayed gastric emptying. Multidisciplinary rationalisation, via pre-insertion optimisation and active de-escalation of CAN and opioids, is essential to prevent avoidable iatrogenic harm.