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• W3209970022 abstract "We read with great interest the study by Ye et al1Ye Y. et al.Gastroenterology. 2022; 162: 109-121.e5Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar on epidemiology of gastroparesis derived from an insurance claims database. The authors are to be congratulated on one of the largest prevalence studies of gastroparesis from the United States. The Clinformatics Data Mart database (Optum, Eden Prairie, MN) was used to identify International Classification of Diseases diagnosis of gastroparesis coded at one of the following: (1) hospital discharge, (2) 2 outpatient visits 30 days apart or (3) at least 1 diagnosis of gastroparesis within 90 days of undergoing gastric emptying scintigraphy (GES). They identified 71,775 patients with gastroparesis with a prevalence of 268 per 100,000 persons, with the highest prevalence among those aged between 58 and 64 years. The prevalence of diabetic gastroparesis was 4 times of that of idiopathic gastroparesis. Only 36% of the cohort classified as having gastroparesis underwent GES testing before the index date, and the remaining 64% were identified through diagnostic codes. Although the cohort is population-based, we believe several factors may influence the described epidemiology of gastroparesis. The cohort with health insurance is likely to demographically biased, as noted in 40% patients in this cohort being aged >65 years and 71% being White. When a “definitive” gastroparesis definition was used, the prevalence showed much more of a homogenous spread across the age ranges than when a “probable” or “possible” diagnosis of gastroparesis was used. The National Institutes of Health Gastroparesis Clinical Research Consortium (GpCRC) has enrolled >1300 patients with gastroparesis and functional dyspepsia into its registries. Although the population is tertiary-care referral-based, these registries have substantially informed us about the epidemiologic and clinical characteristics of gastroparesis. In the GpCRC studies, patients with idiopathic gastroparesis were predominantly women (88%), and 46% were overweight.2Parkman H.P. et al.Gastroenterology. 2011; 140: 101-115Abstract Full Text Full Text PDF PubMed Scopus (209) Google Scholar A significantly higher proportion of Hispanics had gastroparesis of diabetic etiology (59%) than non-Hispanic Whites (28%). Additionally, a significantly higher proportion of non-Hispanic Blacks (60%) had gastroparesis of diabetic etiology than of non-Hispanic Whites (28%).3Parkman H.P. et al.Clin Gastroenterol Hepatol. 2019; 17: 1489-1499.e8Abstract Full Text Full Text PDF PubMed Scopus (20) Google Scholar The current study by Ye et al1Ye Y. et al.Gastroenterology. 2022; 162: 109-121.e5Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar did not find any differences in distribution of sex or race/ethnicity based on the etiology of gastroparesis. Although this study and the GpCRC have very different enrollment strategies, it is possible that the demographic and racial distribution of diabetic and idiopathic gastroparesis lies somewhere in between what is estimated by these 2 data sets. Considering only 26% of cases were identified using the GES criterion, it is plausible that several of the diagnostic codes are based on “provider assumption of gastroparesis,” especially in the setting of diabetes, which constituted 57% of patients, with 64% of those having chronic complications of diabetes such as pulmonary, vascular, and triopathy (neuropathy, retinopathy, and nephropathy). Several of these patients might have symptoms due to functional dyspepsia, which has significant symptom overlap with gastroparesis4Pasricha P.J. et al.Gastroenterology. 2021; 160: 2006-2017Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar or rapid gastric emptying, which can cause symptoms often indistinguishable from gastroparesis, especially in the setting of diabetes.5Bharucha A.E. et al.Clin Endocrinol (Oxf). 2009; 70: 415-420Crossref PubMed Scopus (114) Google Scholar It also highlights underuse of GES in making the diagnosis of gastroparesis. In the prior electronic medical record-based prevalence study, a greater proportion of patients with type 1 diabetes were found to have a concurrent diagnosis of gastroparesis compared with type 2 diabetes (4.6 vs 1.3%).6Syed A.R. et al.J Clin Gastroenterol. 2020; 54: 50-54Crossref PubMed Scopus (24) Google Scholar In the current report, the prevalence of gastroparesis in type 2 diabetes was 9-fold of that in type 1 diabetes. It is also not clear whether the ≥1 inpatient or ≥2 outpatient diagnosis criteria refer to the primary diagnosis. The regional/state distribution may be biased by statewide differences in registrations in the Optum network. Clarification on these may allow better appraisal of the data presented. This study reports 11% of gastroparesis being idiopathic, which is lower than the proportion reported in the GpCRC registries7Parkman H.P. et al.Clin Gastroenterol Hepatol. 2011; 9 (quiz: e133–e134): 1056-1064Abstract Full Text Full Text PDF PubMed Scopus (128) Google Scholar as well as other United States population-based cohorts.6Syed A.R. et al.J Clin Gastroenterol. 2020; 54: 50-54Crossref PubMed Scopus (24) Google Scholar,8Jung H.K. et al.Gastroenterology. 2009; 136: 1225-1233Abstract Full Text Full Text PDF PubMed Scopus (325) Google Scholar This could be due to the postsurgical (15%) and drug-induced (12%) gastroparesis reported in the current study. Other prevalence studies, including those from GpCRC, include drug-induced gastroparesis in the idiopathic category. The authors used a “3 months” criterion for onset of symptoms for postsurgical and drug-induced gastroparesis. Although intuitive, there is no clear rationale for gastroparesis to present within 3 months after these events or an obligatory attribution of gastroparesis to these events on the basis of duration alone. It would also have been helpful to know the distribution of drugs attributed to cause gastroparesis, particularly because drugs, such as tricyclic antidepressants, were not shown to cause a delay in gastric emptying.9Lacy B.E. et al.Am J Gastroenterol. 2018; 113: 216-224Crossref PubMed Scopus (28) Google Scholar In the future, it would be helpful for the field to reach consensus on the drugs most convincingly attributed to gastroparesis and the duration of use and whether to exclude those cases from idiopathic gastroparesis. The insurance claims databases have other inherent limitations. Unlike electronic medical records, a claims database does not allow assessment of nonprescription drugs. Additionally, clinically relevant data are not available (eg, symptoms and results of GES), which raises the possibility of unmeasured selection bias. It is also not clear whether a pre-existing diagnosis of gastroparesis before the Optum registration (2000–2019) can be excluded, especially in patients where gastroparesis is attributed to drugs and surgery. Despite the limitations, the study by Ye et al1Ye Y. et al.Gastroenterology. 2022; 162: 109-121.e5Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar provides a robust platform for understanding population-based epidemiology as well as medication use in gastroparesis. It indirectly highlights the stagnant pipeline for effective therapeutic options and the need for transforming the therapeutic landscape. These results also highlight the significant number of comorbidities that exist with gastroparesis that likely influence the disease presentation and natural history. These comorbidities also pose challenges for drug development because some of these patients are likely to be on medications with potential for drug interactions. Lastly, the results reflect the relative underuse of physiological measurements in making the diagnosis of gastroparesis. We welcome this important epidemiologic study, which will guide investigators in planning future gastroparesis research to refine prevalence estimates and to identify and quantify independent risk factors and treatments for this debilitating condition. Epidemiology, Etiology, and Treatment of Gastroparesis: Real-World Evidence From a Large US National Claims DatabaseGastroenterologyVol. 162Issue 1PreviewIn 100,000 US adults, 267.7 have gastroparesis (falling to 21.5 when using a strict disease definition). Causes of gastroparesis include diabetes (57.4%), surgery (15.0%), medication (11.8%), and unknown/uncertain reasons (11.3%). Full-Text PDF Open Access" @default.
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• W3209970022 title "Epidemiology of Gastroparesis in the United States" @default.
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