Gastroparesis Symptoms Differ Among Older and Younger Adults

Older adults with upper gastrointestinal disorders may not report specific symptoms or could be asymptomatic, leading to a late diagnosis or severe complications.

Older adults with gastroparesis tend to present with early satiety and bloating, whereas younger patients present with vomiting and abdominal pain, according to study findings published in The American Journal of the Medical Sciences.

Researchers conducted a population study to assess the differences in symptoms, demographics, and management options between older and younger adults with gastroparesis. They extracted data from the Nationwide Inpatient Sample and Health Care Cost and Utilization Project (NIS-HCUP) database collected between  2012 and 2014. 

All study participants (N=50,170) had a primary diagnosis of gastroparesis as defined by the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) coding system. Older adults were aged 70 years or older and comprised the study group (n=6265). Younger adults were aged 69 years or younger and comprised the control group (n=43,905).

The primary outcome was to determine the differences in gastroparesis symptoms between older adults and younger adults. The secondary outcome was to analyze independent determinants and surgical procedures for gastroparesis in the older adult population. 

The comorbidities identified among the study participants were nausea, vomiting, concomitant nausea with vomiting, persistent vomiting, early satiety, bloating or flatulence, and upper abdominal pain.

We recommend for older adults that endoscopy should be considered first, due to the possible increased likelihood of structural abnormalities.

There were more men in the older adult population compared with the control group (odds ratio [OR], 1.22; 95% CI, 1.16-1.3; P <.0001). The study group also had more White participants compared with the control group (76.9% vs. 64.1%, respectively).

The study population was more likely to experience early satiety and bloating or flatulence. Older adults were also less likely to experience vomiting, nausea with vomiting, persistent vomiting, or abdominal pain. Additionally, older adults had a 61% increased likelihood of weight loss compared with younger adults.

Surgical procedures more common in the older adult population included gastrotomy and percutaneous endoscopic gastrostomy (PEG; OR, 7.01; 95% CI, 2.03-24.23; P <.0001) vs the younger adult population (OR, 1.89; 95% CI, 1.54-2.31; P <.0001), respectively. The older adult population was less likely to undergo gastric electrical stimulation (GES; OR, 0.22; 95% CI, 0.15-0.32; P <.0001).

Weighted multivariate analysis demonstrated that older adults were more likely to undergo gastrostomy and PEG, whereas younger adults were more likely to receive a pyloroplasty, endoscopic pyloric dilation, and GES. 

Study limitations include the risk for bias of due to the reporting system, the inability to conduct community-level studies, and the inability to estimate differences in delayed gastric emptying between groups. 

“We recommend for older adults that endoscopy should be considered first, due to the possible increased likelihood of structural abnormalities,” study authors conclude.

References:

Saleem S, Tarar ZI, Aziz M, Ishtiaq R, Guzman Rojas P, Abell TL. Gastroparesis in geriatrics population: a United States population study. Am J Med Sci. Published online Dec 11, 2022. doi:10.1016/j.amjms.2022.12.003