M2024 Ghrelin Stimulates Gastric Contraction in a Specific Physiological Condition In Vivo and In Vitro in the House Musk Shrew (Suncus Murinus), a Ghrelin-And Motilin-Producing Laboratory Animal

Background: While gastroparesis usually presents with nausea or vomiting, abdominal pain also may be part of the presenting illness. The importance of pain in gastroparesis and its associated factors are largely unexplored. Aims: Define abdominal pain prevalence in gastroparesis and relate to demography, etiology, severity, quality of life, gastric retention, and analgesic vs. prokinetic/antiemetic drug use. Methods: 339 gastroparesis patients were enrolled from 6 centers of the NIDDK Gastroparesis Clinical Research Consortium from 1/ 07-11/09. Survey, exam, and gastric emptying data were compared in those with pain vs. no pain and pain as the predominant symptom vs. predominant nausea or vomiting. Results: 243 patients (72%) noted abdominal pain; pain was the predominant symptom in 65 (19%) vs. nausea or vomiting in 194 (57%). On Patient Assessment of GI Symptoms surveys, upper abdominal pain scores were higher in those with pain (3.5±1.4) vs. no pain (1.9±1.8, P<0.0001). Lower abdominal pain scores also were higher with (2.3±1.7) vs. no pain (1.4±1.5, P<0.0001). Higher percentages of those with pain were women (86 vs. 76%, P= 0.04) and had idiopathic etiology (70 vs. 54%, P=0.007). Infection-like prodromes were similar with (17%) vs. no pain (19%, P=0.75). Investigator-rated gastroparesis severity was similar with vs. no pain (P=0.25). Patient Assessment of GI Quality of Life (PAGI-QOL) scores were lower with pain (2.3±1.1 vs. 2.8±1.1, P<0.0007). SF-36 physical function (P<0.0001), energy/fatigue (P=0.004), emotional wellbeing (P=0.02), social function (P= 0.0004), pain (P<0.0001), and general health (P=0.02) scores were lower with pain. 4 hr gastric retention (normal <10%) was similar with (32±24%) vs. no pain (33±22%, P=0.91). Opiate use was higher with pain (P<0.0001), while antidepressant (P=0.22), neuropathic pain modulator (P=0.10), prokinetic (P=0.40), and antiemetic (P=0.13) use did not significantly differ. Compared to those with predominant nausea or vomiting, patients with predominant pain had higher upper abdominal pain scores (P<0.0001), but similar severity (P= 0.91), lower abdominal pain scores (P=0.21), 4 hr gastric retention (P=0.96), PAGI-QOL and SF-36 scores (P=NS). Conclusions: Abdominal pain is prevalent in gastroparesis and is predominant in 1 in 5 patients. Pain, like nausea and vomiting, impairs quality of life. Pain is associated with female gender and idiopathic etiology but not gastric retention. Increased opiate use reflects its health care impact and underscores a need to investigate new treatment options for pain. Our findings provide insight into this important symptom and emphasize its negative influence in gastroparesis.