A Retrospective Analysis of Lifestyle Factors, Prokinetic Use, and Clinical Outcomes in Patients With Gastroparesis and Comorbid Hepatic Fibrosis at King Hussein Medical Center

Background: Gastroparesis and metabolic dysfunction-associated steatotic liver disease (MASLD) frequently co-exist in patients with metabolic syndrome and diabetes mellitus.However, the impact of elevated calculated fibrosis risk on gastroparesis outcomes remains poorly understood.Objective: This study evaluated the association between documented lifestyle advice, prescribed prokinetic regimens, and symptom improvement in patients with gastroparesis and elevated calculated fibrosis risk based on non-invasive indices.Methods: A retrospective cohort study included 240 adult patients with confirmed gastroparesis (by gastric emptying scintigraphy) at a tertiary hospital (January 2022 to January 2024).Patients were stratified by calculated fibrosis risk using the Fibrosis-4 (FIB-4) Index and MASLD Fibrosis Score as low risk (n = 156) and elevated risk (n = 84).Intermediate and high categories were combined to ensure adequate statistical power, and patients were classified as elevated risk if either score fell within the intermediate or high-risk category.Data on demographics, gastroparesis aetiology, lifestyle recommendations, prokinetic prescriptions, and serial Gastroparesis Cardinal Symptom Index (GCSI) scores were collected.The primary outcome was symptom improvement (a reduction of at least one point in GCSI) at 12 months.Results: Patients with elevated calculated fibrosis risk had higher baseline GCSI scores (3.4 ± 0.7 vs. 2.9 ± 0.8, p < 0.001), lower rates of symptom improvement (38 of 84 (45.2%) vs. 105 of 156 (67.3%), p < 0.001), and required higher rates of prokinetic dose escalation (33 of 84 (39.3%) vs. 33 of 156 (21.2%), p = 0.004).Documented lifestyle advice was associated with improved outcomes only in low-risk patients (OR = 2.45, 95% CI: 1.28-4.69),but not in those with elevated calculated fibrosis risk (OR = 1.12, 95% CI: 0.58-2.16).On multivariable analysis, independent predictors of poor symptom response included elevated calculated fibrosis risk (OR = 0.38, 95% CI: 0.21-0.69)and diabetes duration >10 years (OR = 0.45, 95% CI: 0.25-0.81).The total number of patients achieving symptom improvement was 143 of 240 (59.6%).Conclusions: Elevated calculated fibrosis risk identifies a subgroup of gastroparesis patients with more severe symptoms and poorer response to standard interventions.These findings are exploratory and require confirmation in prospective, multicentre studies with validated liver assessment before any clinical recommendations can be made.