Purpose: Manifestation of gastroparesis is very heterogeneous, and clinical complications are poorly defined. Misconception of gastroparesis among physicians may be common. Aims of Study: To determine physician's perception of gastroparesis and to identify areas that need further research and education.
Methods: A physician survey was prospectively developed and tested for validity and clarity. The 24-item survey included questions on the etiology, symptoms, management, and perceived complications of gastroparesis. Physician's feedback included rated responses by Likert scale (1–5) and ranked responses by priority. Surveys were returned by prepaid self-addressed envelope or fax. 3,161 surveys were mailed to internal medicine (IM), family practice (FP) and gastrointestinal (GI) physicians in each state using an online physician directory (alphabetically and proportional to state population). Another 497 surveys were sent to local physicians from a local directory. ANOVA and t-test with SPSS were utilized.
Results: 397 surveys were returned. 55% of physicians practiced >15 yrs, and 84% were in private practice. 86% of responses were from national survey and 14% from local survey. Physician demographics were 30% IM, 25% FP, and 45% GI. Physicians ranked diabetes (70%) as the most common cause of gastroparesis, followed by idiopathic (21%) and post-surgical (9%). Postprandial epigastric pain (61%) was ranked as the most frequent symptom of gastroparesis, followed by retching/vomiting (20%) and heartburn/regurgitation (19%). 60% believed scintigraphy T1/2 is an accurate measurement of gastric emptying. One-third believed gastric electrical stimulation was beneficial as treatment of gastroparesis. Physician's perception of a clinically significant complication for severe gastroparesis are shown in the table. Physicians rated abdominal pain higher than weight loss, hospitalization for dehydration, and malnutrition (P < 0.01). There were other small, but significant, differences in the approach to gastroparesis between IM/FP vs. GI and private vs. academic physicians. There were no differences between national and local physicians.
Conclusion: 1) Abdominal pain is perceived as a marker of severe gastroparesis by most physicians, more than weight loss, dehydration, and malnutrition. 2) Complications of gastroparesis are difficult to define. 3) More physician education on gastroparesis is needed.
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Table: Significant Complications of Severe Gastroparesis
