Elevated Incidence of Retained Food at Upper Endoscopy in Cirrhotic Patients and Possible Association With Portal Hypertension: 905

Introduction: Liver cirrhosis has been associated with delayed gastric emptying. The factors that contribute to this phenomenon have not been fully elucidated. The presence of gastric food contents on esophagogastroduodenoscopy (EGD) can indicate delayed gastric emptying. In the general population, less than 1% of EGDs are notable for retained food. We aimed to determine the frequency of retained food in cirrhotic patients undergoing EGD and to identify patient characteristics associated with delayed gastric emptying in cirrhosis. Methods: We performed a retrospective cohort study of cirrhotic subjects who underwent EGD for the indication of varices screening or surveillance at a tertiary academic medical center between 2000-2015. Exclusion criteria included age less than 18, intra-luminal mass on endoscopy, mechanical bowel obstruction, prior diagnosis of gastroparesis, and opioid use within 24 hours prior to EGD. Characteristics of patients with and without retained food on EGD were compared using Kruskall-Wallis test for continuous variables and chi-squared or Fisher's exact test for categorical variables as appropriate. Statistical analysis was performed using STATA v14.0 (College Station, TX). Results: A total of 980 charts were reviewed, 249 of which met inclusion criteria. Retained food at EGD was documented in 12.5% (n=31) of cirrhotic subjects. Characteristics associated with retained food included thrombocytopenia (p=0.002), portal hypertensive gastropathy (p=0.031), history of esophageal varices (p=0.049), diabetes mellitus (p=0.004) and chronic opioid use (p=0.002). All cirrhotics with portal hypertension, as defined by thrombocytopenia, portal hypertensive gastropathy or history of esophageal varices, had retained food at EGD (Table 1). Further, a history of esophageal varices predicted retained food when controlling for diabetes and opioid use (odds ratio [OR] 2.8, 95% CI 1.07, 7.51, p=0.036) (Table 2).Table: Table. Patient Characteristics in Cirrhotics With and Without Retained Food on EGDTable: Table. History of Esophageal Varices Predicts Delayed Gastric EmptyingConclusion: Cirrhotic patients have a significantly higher frequency of retained food at EGD than the general population. Portal hypertension is associated with delayed gastric emptying, even when controlling for diabetes and opioid use. Providers who care for cirrhotic patients should have a high index of suspicion for symptoms related to delayed gastric emptying. Future studies should focus on the clinical consequences of impaired gastric emptying in cirrhotic patients.