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Journal article
Disparities in presentation and outcomes after surgery for medically refractory gastroparesis: the impact of demographic and socioeconomic status
Journal of gastrointestinal surgery, v 30(3), 102312
Mar 2026
PMID: 41534487
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Abstract
Gastroparesis is a debilitating disorder, and surgical therapy can provide meaningful improvement in patients who remain symptomatic despite medical treatment. However, patients often present with variable disease severity, and the influence of demographic and socioeconomic factors on this variability and on postoperative outcomes remains poorly defined. This study aimed to evaluate the effect of demographic status and socioeconomic status (SES) on preoperative characteristics and postoperative outcomes in patients who underwent surgery for medically refractory gastroparesis.
All patients who underwent surgical treatment of medically refractory gastroparesis between 2012 and 2024 at a tertiary foregut center were retrospectively analyzed. Demographics, gastroparesis etiology, gastric emptying, and Gastroparesis Cardinal Symptom Index (GCSI) scores were compared across sex, race, age, and SES groups. SES classification was derived from zip code-level United States census data. Surgical procedures included pyloroplasty, gastric peroral endoscopic pyloromyotomy, and gastric electrical stimulation.
A total of 387 patients were included (82.4% female; mean age of 51.3 ± 15.6 years). Idiopathic (62.3%) and diabetic (23.9%) etiologies predominated. Overall, GCSI total score improved significantly (median: 3.1 [IQR, 2.5-3.9] to 2.4 [IQR 1.6-3.3]; P <.001), and gastric retention at 4 h decreased (29.0% [IQR, 17.0%-44.9%] to 8.0% [IQR, 1.0%-24.0%]; P <.001). African American patients presented with higher baseline GCSI total score (median: 4.3 [IQR, 3.3-4.8] vs 3.1 [IQR, 2.4-3.8]; P =.011) and continued to report higher postoperative symptom scores (GCSI total score: 3.1 vs 2.4; P =.031). Similarly, patients with low SES demonstarted a trend toward more severe preoperative symptoms and higher gastric retention but achieved postoperative improvement comparable with those with higher SES. A significant correlation between preoperative gastric emptying at 4-hour retention and GCSI total score was observed only in men, both preoperatively (r = 0.46; P =.049) and postoperatively (r = 0.60; P =.025). Younger patients were less likely to have symptom resolution (P =.035).
Surgical treatment achieved durable improvement in medically refractory gastroparesis, with similar postoperative gains across SES groups. Persistent symptoms in African American and younger patients and sex-specific differences in symptom-motility correlation suggest multifactorial mechanisms beyond motility alone.
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Details
- Title
- Disparities in presentation and outcomes after surgery for medically refractory gastroparesis: the impact of demographic and socioeconomic status
- Creators
- Emma Venard - Allegheny Health NetworkSven E Eriksson - Allegheny Health NetworkMargaret Gardner - Allegheny Health NetworkPing Zheng - Allegheny Health NetworkShahin Ayazi (Corresponding Author) - Drexel University, Surgery
- Publication Details
- Journal of gastrointestinal surgery, v 30(3), 102312
- Publisher
- Elsevier
- Number of pages
- 9
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Surgery
- Web of Science ID
- WOS:001669882900001
- Other Identifier
- 991022154473404721