Risk stratification for gastroparesis treatment failure: The role of frailty and recurrent h. pylori infection: A retrospective study from king Hussein medical center

Background: A significant proportion of patients with gastroparesis experience suboptimal response to first-line prokinetic therapy. Clinical frailty and recurrent Helicobacter pylori infection are patient-specific factors frequently encountered in clinical practice, yet their combined role as independent risk factors has not been systematically evaluated.
Objective: To identify clinical predictors of gastroparesis treatment failure, focusing on frailty and recurrent H. pylori infection.
Methods: A retrospective case-control study of 188 patients with confirmed gastroparesis (idiopathic or diabetic) managed between January 2021 and January 2024. Cases (n=62) met criteria for treatment failure (persistent severe symptoms, hospital admission, enteral tube feeding, or escalation to second-line therapies within 12 months). Controls (n=126) had adequate clinical response. Data on modified Frailty Index (mFI), recurrent H. pylori infection (≥2 positive tests), comorbidities, and medications were collected.
Results: Mean age 52.4±14.8 years, 64.9% female, 58.5% diabetic. Treatment failure occurred in 33.0%. Recurrent H. pylori were documented in 28.7% overall (46.8% of cases vs. 19.8% of controls, p<0.001). Frailty (mFI ≥0.27) was present in 36.2% of cases vs. 15.1% of controls (p<0.001). Independent predictors: recurrent H. pylori (aOR=3.85, 95% CI: 1.92–7.72), frailty (aOR=3.12, 95% CI: 1.48–6.58), diabetes duration >10 years (aOR=2.45, 95% CI: 1.28–4.69), and baseline GCSI ≥3.0 (aOR=2.18, 95% CI: 1.12–4.24). Frailty and recurrent H. pylori had synergistic effects (OR=5.82, 95% CI: 2.45–13.82).
Conclusion: Frailty and recurrent H. pylori infection are strong, independent predictors of gastroparesis treatment failure. Their combination identifies a very high-risk population, supporting comprehensive initial evaluation to guide treatment intensity.