University of Pennsylvania Health System Philadelphia, PA
Iboro C. Umana, MD, PhD, Samantha Ellison, Rosemarie Hernandez, Kimberly Forde, MD, MHS, James C. Reynolds, MD, Nitin K. Ahuja, MD, MS; University of Pennsylvania Health System, Philadelphia, PA
Introduction: Gastrointestinal dysmotility and functional gastrointestinal disorders (FGID) may be associated with intolerance of oral nutrition and/or risk of malnutrition. When severe, this malnutrition can require initiation of supplemental (enteral or parenteral) nutrition. We performed a retrospective case-control study to identify factors associated with initiation of nutrition support in FGID/dysmotility patients. Methods: We conducted a chart review of patients ( >18 years old) hospitalized at our institution between 2016 and 2019 with at least one prespecified FGID/dysmotility discharge diagnosis and at least one visit to our ambulatory gastroenterology practice. Cases were defined as patients initiated on enteral or parenteral nutrition within the designated study period. Patients with inflammatory bowel disease, cirrhosis, active malignancy, cystic fibrosis, dementia, or history of gastrointestinal surgery were excluded. Controls were defined as patients with dysmotility and/or FGIDs who were hospitalized without receiving nutrition support. Cases and controls were compared with Fisher’s exact or Chi squared testing as appropriate for categorical variables and Wilcoxon rank-sum for continuous variables. Conditional logistic regression was used to determine factors associated with institution of nutrition support, accounting for matching on age and gender. Results: 768 patients were screened, with 19 cases and 71 controls meeting criteria for analysis. Gastroparesis was the most common diagnosis requiring initiation of supplemental nutrition (7/19, 37%). Relative to controls, cases were associated with younger age, lower BMI, comorbid Ehlers-Danlos syndrome, comorbid postural orthostatic tachycardia syndrome (POTS), and multiple dysmotility/FGID diagnoses (Table 1). In an adjusted regression analysis, BMI was associated with nutrition support. There was a trend towards multiple dysmotility/FGID diagnoses being associated with nutrition support. Discussion: In this retrospective case-control study, patients initiated on supplemental nutrition were significantly younger, of lower BMI, and more likely to have EDS, POTS, and multiple dysmotility/FGID diagnoses as compared with hospitalized controls not initiated on supplemental nutrition. Lower BMI remained a significant predictor of nutrition support on matched regression analysis. The overall prevalence of supplemental nutrition among patients with dysmotility/FGID is low, but the presence of risk factors may warrant closer monitoring.
Table 1. Unmatched comparison between dysmotility/FGID patients with and without required initiation of nutritional support
Disclosures: Iboro Umana indicated no relevant financial relationships. Samantha Ellison indicated no relevant financial relationships. Rosemarie Hernandez indicated no relevant financial relationships. Kimberly Forde indicated no relevant financial relationships. James Reynolds indicated no relevant financial relationships. Nitin Ahuja indicated no relevant financial relationships.