Linda Anh B. Nguyen

Clinical-histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium: Clinical-histological associations in gastroparesis

Background  Cellular changes associated with diabetic (DG) and idiopathic gastroparesis (IG) have recently been described from patients enrolled in the Gastroparesis Clinical Research Consortium. The association of these cellular changes with gastroparesis symptoms and gastric emptying is unknown. The aim of this study was to relate cellular changes to symptoms and gastric emptying in patients with gastroparesis.

Diabetic and idiopathic gastroparesis is associated with loss of CD206-positive macrophages in the gastric antrum

Animal studies have increasingly highlighted the role of macrophages in the development of delayed gastric emptying. However, their role in the pathophysiology of human gastroparesis is unclear. Our aim was to determine changes in macrophages and other cell types in the gastric antrum muscularis propria of patients with diabetic and idiopathic gastroparesis.

Relating gastric scintigraphy and symptoms to motility capsule transit and pressure findings in suspected gastroparesis

Wireless motility capsule (WMC) findings are incompletely defined in suspected gastroparesis. We aimed to characterize regional WMC transit and contractility in relation to scintigraphy, etiology, and symptoms in patients undergoing gastric emptying testing.

Mo1292 Correlation of Fermentable Carbohydrate Consumption With Symptoms and Quality of Life in Patients With Diabetic and Idiopathic Gastroparesis

G A A b st ra ct s SIBO test results were related to (i) 4 hr gastric retention (mild 10-20%, moderate >2035%, severe >35%), (ii) retained gastric food on endoscopy, and (iii) etiology and opiate use. Results: Breath tests were positive in 52% (H2 41% > CH4 16%, P 50% of gastroparesis patients. Pronounced gastric emptying defects do not increase SIBO prevalence, but may worsen SIBO severity as reflected by increased H2 production. Retained food in the stomach increases hydrogen andmethane release, suggesting potential gastric microbial reservoirs that seed the small bowel. Postsurgical patients show increased predilection to SIBO. Opiate use promotes trends to increased hydrogen release. Methane production with retained food and in postsurgical patients suggests varying microbial profiles in SIBO. These findings define factors associated with the prevalence and severity of SIBO in gastroparesis. Table 1: Relation of Breath Testing to Gastric Emptying and Food Retention

1088 Outcomes and Predictors of Improvement in Patients With Gastroparesis Followed Prospectively for 48 Weeks

and SMW total scores remained when analysis was limited to normal or delayed gastric emptying (p<0.05, p<0.05). Only 13% (3/24) needed tube feeds and 13% (3/24) parenteral nutrition after GES. School absences decreased from 57% to 31% of school days. Overall, 65% (13/20) reported their health was much improved after GES versus 15% (3/20) the same or worse. The majority (15/20) were satisfied with GES. Three were not satisfied due to lack of improvement, one developed back pain and another was later diagnosed with an eating disorder. Five reported complications. Four had discomfort or tenderness at the implantation site and another had a dead battery. Conclusions: In the largest series to date of pediatric patients who have undergone GES for GP and/or FD, we have found significant and sustained improvement not only in upper GI symptoms but also in quality of life and perception of global health. Patients were less dependent on tube feeding or parenteral nutrition and had fewer school absences. The majority is satisfied with the decision to place GES. Future studies are needed to assess for possible placebo effect and to evaluate predictors of outcome and long-term prognosis.

296 Effectiveness of Gastric Electrical Stimulation in Gastroparesis: Results From a Large Prospectively Collected Database of a National Gastroparesis Registry

Effectiveness of Gastric Electrical Stimulation in Gastroparesis: Results From a Large Prospectively Collected Database of a National Gastroparesis Registry Thomas L. Abell, Richard W. McCallum, Kevin P. May, Laura Wilson, Henry P. Parkman, William L. Hasler, Kenneth L. Koch, William J. Snape, John O. Clarke, Linda Anh B. Nguyen, Irene Sarosiek, Gianrico Farrugia, Jorge Calles-Escandon, James Tonascia, Linda A. Lee, Frank A. Hamilton, Pankaj J. Pasricha

299 Diabetic and Idiopathic Gastroparesis Is Associated With Loss of Antral Interstitial Cells of Cajal and CD206 Positive Macrophages

Effectiveness of Gastric Electrical Stimulation in Gastroparesis: Results From a Large Prospectively Collected Database of a National Gastroparesis Registry Thomas L. Abell, Richard W. McCallum, Kevin P. May, Laura Wilson, Henry P. Parkman, William L. Hasler, Kenneth L. Koch, William J. Snape, John O. Clarke, Linda Anh B. Nguyen, Irene Sarosiek, Gianrico Farrugia, Jorge Calles-Escandon, James Tonascia, Linda A. Lee, Frank A. Hamilton, Pankaj J. Pasricha

Su1431 Abdominal Pain in Gastroparesis: A Common Symptom Associated With Gender, Anxiety and Other Gastroparesis Symptoms

Abdominal pain is seen in many patients with gastroparesis, but is not well characterized or recognized as a symptom of gastroparesis. Aims: 1) Describe characteristics of abdominal pain in gastroparesis; and 2) Determine differences in abdominal pain between diabetic (DG) and idiopathic gastroparesis (IG). Methods: Gastroparetic patients were enrolled at 8 centers into the NIH Gastroparesis Registry from September 2012 to October 2014. Patients had symptoms of gastroparesis for >12 weeks, delayed gastric emptying, negative endoscopy. History and physical examinations, questionnaires assessing symptoms (PAGI-SYM), quality of life (PAGI-QOL, SF-36), psychologic state (Beck Depression Inventory, State Trait Anxiety Index, PHQ-15), and a questionnaire characterizing abdominal pain were obtained. Results: 117 gastroparesis patients were enrolled: 74 IG, 40 DG, and 3 Post-Nissen. Overall, 92% of patients were experiencing abdominal pain. Abdominal pain was described as discomforting (38%) or distressing (27%), occurring every day in 52%, and most often localized in the upper middle portion of the abdomen (35% of patients) or middle central portion (19%). Abdominal pain worsened with eating in 52%, occurred at night (46%), and interfered with sleep (29%). Severity of upper abdominal pain, assessed by PAGI-SYM, was severe or very severe in 35% of patients, was more severe in females (p=0.001), and associated with decreased quality of life by PAGI-QOL (p=0.03) and SF-36 physical (p=0.11) and mental (p=0.10) components. Abdominal pain severity was associated with other symptoms of gastroparesis: nausea/vomiting subscale (p=0.03), early satiety/postprandial fullness subscale (p<0.001), and bloating subscale (p=0.002); but not gastric emptying. Abdominal pain severity was associated with other pain-related conditions, IBS (p=0.02) and migraine headaches (p=0.03), but not fibromyalgia. Upper abdominal pain was associated with increased PHQ-15 somatic symptom score (p=0.007), state anxiety (p=0.04), but not trait anxiety (p= 0.25) or depression (p=0.22). Upper abdominal pain severity was not significantly different between IG and DG (2.9±1.7 vs 2.5±1.7; p=0.30). Abdominal pain occurred with eating more often in IG (63 vs 35%; p<0.01) and was shorter duration in IG: less than one hour in 55% of IG vs 9% of DG; p=0.003. Upper abdominal pain severity was independently associated with female gender (OR 18.9; p=0.01), other gastroparesis symptoms (OR 2.8; p<0.001), and state anxiety score (OR=1.03; p=0.04). Conclusions: Abdominal pain is common in patients with gastroparesis, both idiopathic and diabetic. Upper abdominal pain severity is associated with decreased quality of life, female gender, anxiety and other gastroparesis symptoms. Thus, abdominal pain in gastroparesis patients needs understanding and treatment to reduce morbidity from this important symptom.

Mo1288 Intra-Operative Electrophysiological and Interstitial Cell of Cajal Findings in Patients With the Symptoms of Gastroparesis

Intra-Operative Electrophysiological and Interstitial Cell of Cajal Findings in Patients With the Symptoms of Gastroparesis Archana Kedar, Thomas L. Abell, Cheryl E. Bernard, Gianrico Farrugia, Christopher J. Lahr, William L. Hasler, Kenneth L. Koch, Richard W. McCallum, Linda Anh B. Nguyen, Henry P. Parkman, Pankaj J. Pasricha, Irene Sarosiek, William J. Snape, Aynur Unalp, James Tonascia, Jose Serrano, Frank A. Hamilton

Mo2091 Modeling Equations for Prediction of Improvement in Patients With Gastroparesis Based on 48 Week Prospective Outcome Data

Background. The management of patients with gastroparesis remains challenging in many ways including an inability to project the course of the disease in a given patient. In this study, our aim was to determine if how well statistical models can confidently predict symptomatic improvement after a year of standard of care medical treatment. Methods. We studied 358 patients with gastroparesis (including idiopathic as well as that associated with both type 1 and type 2 diabetes mellitus) enrolled in the NIDDK Gastroparesis Clinical Research Consortium (GpCRC) registry. We used logistic regression modeling to determine the degree to which initial characteristics predict symptomatic improvement after 48 weeks of standard of care medical treatment with visits at least every 16 weeks and prescribed medications or other therapies as per the judgment of the treating physician. Improvement was defined as a decline of at least 1 point in the GCSI scores at 48 weeks compared to the baseline score. Regression coefficients, 95% CIs, P-values and areas under the ROC were used to compare a comprehensive model with baseline characteristics such as symptom scores, demographics, lifestyle, gastric emptying, medical history and psychological quality of life (QOL) as predictors vs. a much smaller reduced model (derived using stepwise regression), using only baseline characteristics. Results. Both the comprehensive model and reduced models predicted improvement well (AUROCs .0.70) and there was no significant difference in predictive ability of the smaller model compared to the comprehensive model (P=0.11). See Table 1 for the coefficients, CIs, and P-values and the logistic equation used to predict improvement; see Figure 1 for the ROC comparisons. Conclusions: It is possible to construct a robust predictive equation that identifies patients with gastroparesis that are likely to improve after a year of follow-up, but better models are needed to more fully facilitate counseling of patients as well as top generate hypothesis for interventions to improve outcomes in future studies.