Peripheral neuropathy common in patients with idiopathic, diabetic gastroparesis
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Patients with symptoms of gastroparesis — including those with diabetic and idiopathic etiologies — demonstrated a prevalence for peripheral neuropathy, according to a study published in BMC Gastroenterology.
Researchers further reported that, particularly in patients with idiopathic gastroparesis (IG), this prevalence was associated with more severe gastroparetic symptoms compared with patients with gastroparesis and no peripheral neuropathy (nPN).
“Diabetic gastroparesis is associated with peripheral neuropathy, retinopathy and nephropathy,” Henry P. Parkman, MD, professor of medicine and director of GI Motility Laboratory at Temple University Hospital, told Healio. “We wondered if other forms of gastroparesis had evidence of peripheral neuropathy.”
Parkman and colleagues sought to determine peripheral neuropathy (PN) prevalence in IG, which was defined as non-diabetic, non-postsurgical and not caused by a known disorder; ascertain differences in gastric emptying and gastrointestinal and psychosocial symptoms between patients with gastroparesis symptoms and PN vs. nPN; and compare this relationship to other gastroparesis etiological groups.
Researchers determined PN by a Neuropathy Total Symptom Score-6 (NTSS-6) of greater than 6 and used the Gastroparesis Cardinal Symptom Index (GCSI) for gastroparesis symptoms, grading symptom severity from 0 (no symptoms) to 5 (very severe symptoms).
The cross-sectional analysis included 250 patients with symptoms of gastroparesis. According to NTSS-6 assessment, PN was present in 70 patients (28%), including 22 of 148 (15%) patients with IG, 33 of 61 (54%) patients with type 1 or type 2 diabetes and 11 of 32 (34%) postsurgical patients (P < .01).
Symptoms were more severe in patients with IG and PN vs. nPN and included bloating (4.05 ± 1.17 vs. 2.99 ± 1.61; P < 0.01), abdominal distention (3.86 ± 1.49 vs. 2.45 ± 1.68; P < 0.01) and upper abdominal pain (3.64 ± 1.22 vs. 2.71 ± 1.78; P = 0.03).
Patients with diabetic gastroparesis or postsurgical gastroparesis and PN did not have GI symptoms as severe as patients with IG and PN, researchers reported.
Of 166 patients who underwent gastric emptying (GE) scintigraphy, PN was detected in 32% of patients with delayed GE and 23% of patients with normal GE (P = .049). Among the 15% of patients with IG and PN, PN was detected in 16% with both delayed GE and normal GE, whereas in the 54% of patients with diabetic gastroparesis and PN, PN was detected in 64% with delayed GE and 40% with normal GE. Among the 34% of patients who were non-diabetic and postsurgical with symptoms of gastroparesis and PN, PN was detected in 25% of patients with delayed GE and 40% of patients with normal GE.
Researchers found no significant correlations between PN severity and gastric retention at 2 or 4 hours in any cohort.
“Evidence of peripheral neuropathy might be reason to use symptom modulators for treatment of the neuropathy but also the gastroparesis,” Parkman said, adding the next step will be to “perform this study with objective assessment of peripheral neuropathy by exam or testing.”
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