Gastroparesis following bone marrow transplantation

Patients often develop nausea, vomiting and bloating after bone marrow tran splantation (BMT). These symptoms may interfere with nutrition and the abil ity to take oral medications. Gastroparesis is a recognized cause of these symptoms in non-transplant patients but less is known about patients who un dergo BMT. Between January 1996 and March 1997, a total of 151 patients und erwent BMT. Eighteen patients (12%) developed persistent symptoms suggestiv e of gastroparesis (persistent nausea, vomiting or bloating). Scintigraphic gastric emptying studies were performed to assess for gastroparesis. Proki netic agents were administered at the time of study. The records on these p atients were compared with those of all other patients undergoing BMT durin g the same time period without these symptoms. Nine patients who demonstrat ed delayed gastric emptying were further evaluated with esophagastroduodeno scopy and biopsy. Biopsy samples were reviewed for evidence of graft-versus -host disease (GVHD). Fourteen of 18 patients demonstrated delayed gastric emptying and most responded to prokinetic agents given at the time of study . Age, conditioning regimen, cytomegalovirus antigenemia and acute GVHD did not appear to be associated with the development of gastroparesis. Allogen eic BMT recipients were at higher risk than autologous BMT patients (26% vs 0%, P < 0.0001). Of allogeneic BMT recipients, there was a nonsignificant trend of patients receiving tacrolimus to be less likely to experience gast roparesis than those receiving cyclosporine (27 % vs 48 %, P = 0.08). For t he nine patients undergoing upper endoscopy, GVHD on gastric biopsy was an uncommon finding and was mild when present. Gastroparesis appears to be a c ommon cause of nausea, vomiting and bloating following allogeneic BMT. This may occur less often with tacrolimus than cyclosporine because of the form er agent's prokinetic properties. Patients usually respond to prokinetic dr ugs at the time of scintigraphy. GVHD and CMV infection do not appear to be major contributing factors.