November 2023
Is gastroparesis misdiagnosed often?

Gastroparesis was confirmed in only 20% of patients referred for this presumptive diagnosis.

Gastroparesis and functional dyspepsia are sensorimotor disorders with similar symptoms. Some authorities suggest that they are variations on the same disorder (NEJM JW Gen Med Jun 15 2021 and Gastroenterology 2021; 160: 2006- 2017), whereas other experts believe that they are distinct entities with overlapping symptoms that require different treatments.

In this study, investigators reviewed data on 339 patients referred to a US tertiary centre for presumed gastroparesis. Gastroparesis was the final diagnosis in only 20% of these patients. Functional dyspepsia was diagnosed in 46%, and alternative diagnoses were made in the remaining patients. However, no differences were noted across these groups in presenting symptoms (i.e. nausea, abdominal pain, constipation, vomiting, bloating and early satiety). Prior evaluation had included gastric emptying studies in 58% of patients, but only 7% of these patients had four-hour studies with solid food. Patients who received diagnoses of gastroparesis were more likely than others to have diabetes (40% vs 17%) or to have undergone cholecystectomy (56% vs 38%). Patients received different treatments based on their diagnoses.

Comment: These researchers’ perspective differs from that of the authors of the 2021 study cited above. The current authors conclude that gastroparesis cannot be diagnosed solely based on symptoms. They suggest that functional dyspepsia, which is more prevalent, should be considered initially in most patients. They also emphasise that testing for gastroparesis requires a four-hour gastric emptying study with food.

David J. Bjorkman, MD, MSPH(HSA), SM(Epid), Professor in the Division of Gastroenterology, Hepatology and Nutrition, University of Utah School of Medicine, Salt Lake City, USA.

Cangemi DJ, et al. Misdiagnosis of gastroparesis is common: a retrospective review of patients referred to a tertiary gastroenterology practice. Clin Gastroenterol Hepatol 2023; 21: 2670-2672.

This summary is taken from the following Journal Watch titles: General Medicine, Ambulatory Medicine, Gastroenterology.

Clin Gastroenterol Hepatol