LAUSR

Introduction Patients with idiopathic gastroparesis often have difficult to manage upper gastrointestinal symptoms, resulting in many requiring enteral nutrition and becoming high service users. It is known that many of these patients will have previously experienced significant psychological trauma, including from multiple invalidating healthcare experiences. Previous work on the role of the gut-brain axis emphasises the benefit of a holistic approach to physical symptoms that may manifest as a result of trauma (Kinsinger S. et al. (2015). Snapshot of an integrated psychosocial gastroenterology service. World Journal of Gastroenterology.21(6): 1893–1899). There is therefore a need for a novel approach to this patient population, in particular earlier identification of confounding psychiatric co-morbidities. However measuring the success of such an approach would be challenging, given the lack of data on outcome measures. Methods A pathway for patients presenting with symptoms suggestive of gastroparesis, was created. This included earlier involvement of psychology and psychiatry as part of a multi-disciplinary team (MDT) approach. The MDT would also contribute to long-term management plans from an earlier stage, individualised treatment goals and defined criteria for commencing enteral nutrition. Measures of management success would include anthropometric measurements and use of symptom questionnaires. Outcome measures were identified and the relevant data recorded that reflected both patient and clinician costs of commencing and supporting enteral nutrition. Results Records for 18 patients with idiopathic gastroparesis (17 female, one male) were found, with an average age of 27 at diagnosis. 69% had a confirmed psychiatric diagnosis. Outcome measures were identified, which included number of radiological investigations for upper gastrointestinal symptoms, number of outpatient appointments, time between diagnosis and contact with mental health services, and number and length of stay of inpatient admissions. Diagnosed patients had on average 2.7 inpatient admissions between 01/09/18 - 31/08/19, with an average length of stay of 16.8 days. Conclusion The results have shown that there is a high burden of psychiatric co-morbidity and health service use in patients with idiopathic gastroparesis, supporting the need for the forthcoming implementation of a management pathway that better recognises this at an earlier stage in the patients journey. This study has proposed outcome measures, which may be useful in measuring improvements in the management of this patient population. However more research is required to support the use of such outcome measures.