Exploring Clinical Similarities and Distinctions Between Gastroparesis and Functional Dyspepsia: A Propensity-Matched Cohort Study.

BACKGROUND AND AIMS: Gastroparesis and functional dyspepsia often share overlapping upper gastrointestinal symptoms but may differ in symptom patterns, treatment, and health care utilization. We assessed their clinical similarities and distinctions in the largest national cohort study to date. METHODS: We performed a retrospective cohort study using the TriNetX database, identifying patients through administrative codes. Individuals with structural gastric or small bowel abnormalities or prior gastric surgery were excluded. Gastroparesis required a diagnosis within three months of a gastric emptying study, at least one typical symptom, and an upper endoscopy within 12 months prior. Functional dyspepsia required a diagnosis with prior endoscopy (1-12 months) and symptoms 6-12 months before diagnosis. Primary outcomes were medication use and healthcare utilization; secondary outcomes included symptom burden and coexisting disorders of gut-brain interaction. Propensity score matching (1:1) adjusted for demographics and comorbidities. Relative risks with 95% confidence intervals were calculated. RESULTS: We identified 2488 patients with gastroparesis and 3676 with functional dyspepsia; after matching, 1914 per group remained. Gastroparesis showed greater use of prokinetics (52.7% vs. 19.6%; p < 0.0001) and antiemetics, and higher rates of endoscopy (41.4% vs. 21.2%), emergency visits (45.3% vs. 40.2%), and hospitalization (28.2% vs. 21.6%) (all p < 0.01). Nausea, vomiting, and distension were more frequent in gastroparesis, while epigastric pain predominated in functional dyspepsia (p < 0.0001). CONCLUSION: Gastroparesis and functional dyspepsia show distinct symptom distributions and treatment patterns, with higher health care utilization in gastroparesis, supporting mechanism-based individualized management.