Bloating in Gastroparesis: Prevalence, Impact and Associated Factors

Abstract

Purpose: Patients with gastroparesis usually present with nausea and vomiting, but may also report bloating. The prevalence, impact, and factors associated with bloating in gastroparesis are uninvestigated. The aims of this study were: (i) quantify prevalence of bloating in gastroparesis, (ii) relate bloating to clinical factors and quality of life, (iii) characterize associated factors (obesity, gastric retention, medications). Methods: 353 gastroparesis patients were enrolled from 6 centers of the NIH Gastroparesis Clinical Research Consortium from Jan 2007 to Apr 2009. Validated survey, exam, and scintigraphy data were compared in those with bloating as the predominant symptom on initial query, bloating as a symptom but a non-predominant one, and without bloating. Results: Bloating was predominant in 27 patients (8%) and non-predominant in 171 (48%). 155 (44%) had no bloating. Those with predominant bloating were older (48±12 yr) vs. 40±14 with no bloating and 44±13 yr with non-predominant bloating (P=0.006). No differences in gender (80% female) or etiology (1/3 diabetic) were noted in the 3 groups. Investigator-defined gastric failure (ER visits, supplemental feeding, IV therapy) trended lower with predominant bloating (7.4%) vs. non-predominant and no bloating (both 31%) (P=0.08). Gastroparesis Cardinal Symptom Index nausea/vomiting subscale scores were lowest with predominant bloating (0.7) and highest with no bloating (3.0) (P<0.0001). Visible distention was higher with predominant (82%) and non-predominant bloating (73%) vs. no bloating (43%) (P<0.0001). SF-36 and Patient Assessment of GI Quality of Life scores were no higher with predominant bloating vs. no bloating. BMI, waist, and hip circumference were similar in all groups as was 4 hr gastric retention (median 19%). Antidepressant use related to bloating with an odds ratio of 1.64 (95% CI 1.06-2.54) (P=0.03). Tricyclic use decreased with increasing bloating (no bloating 60%, non-predominant bloating 39%, predominant bloating 12%), while SSRIs increased (no bloating 20%, non-predominant bloating 22%, predominant bloating 62%) (P=0.05). Conclusion: Bloating is prevalent in gastroparesis, relating to age but not gender or etiology, and is predominant in a minority of patients. Bloating predominant patients experience less nausea and vomiting, but note increased visible distention. Bloating does not lead to gastric failure or impair quality of life nor does it correlate with obesity or gastric retention. Increased predominant bloating on SSRIs and reductions on tricyclics warrant study into potential symptom modulation by antidepressants. This study provides insight into this underappreciated symptom of gastroparesis. Supported by NIH U01 DK073975.