Introduction Many patients with gastroparesis (GP) have overlap syndromes such as migraine headaches, fibromyalgia, endometriosis, and interstitial cystitis, all of which may be immune mediated. We have previously shown (GE 1995;108:A734) that hypercoagulability in GP is associated with serological evidence of autoimmunity, which frequently results in vascular complications of therapies for GP. We hypothesized that overlap syndromes may be related to hypercoagulability in GP.
Methods We studied 76 consecutive patients (65 female, 11 male) with a mean age of 43 years who met clinical criteria for gastroparesis. The patients underwent medical evaluation including a history of overlap syndromes and laboratory measurements for both acquired and congenital defects of coagulation: Factor VII, Factor VIII, fibrinogen, antiphospholipid antibodies, activated protein C resistance (APCR), lupus anticoagulant, methylenetetrahydrofolate resistance (MTHFR), and Factor II mutation. Patients were stratified into groups based on which of the overlap disorders and/or depression were present.
Results All patients had gastroparesis symptoms and 70/76 (92%) of the patients had at least one of four overlap disorders: migraine headaches, interstitial cystitis, endometriosis, and fibromyalgia. Forty-two of 76 (55%) patients had a diagnosis of depression; 34/76 (44%) of patients had more than one overlap disorder. Sixty of 76 (78%) patients had both coagulation defects and overlap syndromes.
Conclusion We conclude that overlap disorders are found frequently in patients with drug refractory gastroparesis and may be related to hypercoagulable states through a shared mechanism of altered immunity. Patients with overlap disorders and gastroparesis frequently have depression regardless of the number of overlap disorders present. We conclude that screening gastroparesis patients for overlap disorders may help maximize therapies. Assessing patients with gastroparesis who present with overlap disorders for hypercoagulable states may affect patient management and thus minimize potential complications of therapy.
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