Epidemiology
Well-conducted studies regarding the incidence and prevalence of gastroparesis, using the presence of symptoms along with delayed gastric emptying confirmed by gastric emptying scintigraphy (the test of choice for diagnosis), are lacking.[7] The general lack of epidemiological data relating to gastroparesis may be partly explained by the relative lack of availability of gastric emptying scintigraphy testing in primary care practice.
One population-based study from Olmsted County, Minnesota, addressed the incidence and prevalence of gastroparesis using both the presence of symptoms and scintigraphy-diagnosed delayed gastric emptying; it reported an incidence of 9.8 per 100,000 person-years in women and 2.4 per 100,000 person-years in men. The rate was higher in older people, with an incidence rate of 10.5 in patients aged 60 years and older. Estimated prevalence was 37.8 per 100,000 persons in women and 9.6 per 100,000 persons in men.[8] This study was conducted in a predominantly white community, however, and data regarding the prevalence of gastroparesis in other populations have been lacking.
More recently, one study used data from a large US national claims database to estimate disease prevalence and patient demographics. The overall standardised prevalence of gastroparesis was 267.7 (95% CI 264.8 to 270.7) per 100,000 adults, whereas prevalence of definite gastroparesis (individuals diagnosed within 3 months of gastric emptying scintigraphy testing with persistent symptoms for more than 3 months) was 21.5 (95% CI 20.6 to 22.4) per 100,000 persons. The mean age of patients with gastroparesis was 59 years. Patients with idiopathic gastroparesis were the youngest, with a mean age of 51 years. Patients with type 1 diabetes had a similar mean age of 52 years, whereas those with type 2 diabetes had a higher mean age of 63 years. The study also found that patients with gastroparesis have a significant comorbidity burden; the most frequent comorbidities are chronic pulmonary disease (46.4%), diabetes with a chronic complication (37.3%), and peripheral vascular disease (30.4%).[9]
The prevalence of gastroparesis in diabetic populations in the community in the US is up to 18%.[10][11] This is in contrast to about 65% of people with diabetes evaluated in a tertiary care facility, who had delayed gastric emptying by scintigraphy.[12] This marked difference in the reported prevalence of gastroparesis in community-based studies versus that of tertiary care facilities makes true estimation of prevalence challenging. Selection bias and lack of strict diagnostic criteria have probably exaggerated the true prevalence in tertiary care centre populations.[7]
Gastroparesis tends to occur predominantly in women, who are nearly four times more likely to be diagnosed than men.[7] The reason for this is not clear; hormonal regulation has been postulated as a possible contributor, specifically the role played by progesterone. During the follicular and luteal phases of the menstrual cycle, rises in progesterone levels lead to relaxation of the smooth muscle in the gut, promoting hypomotility and delayed gastric emptying. Moreover, progesterone up-regulates symptoms of gastroparesis significantly during both pregnancy and the luteal phases of the menstrual cycle.[7]
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