Nausea exacerbates symptom burden, quality of life, and functioning in adolescents with functional abdominal pain disorders.

Abstract

Nausea frequently co-exists with functional abdominal pain disorders (FAPDs) and may be linked to a higher disease burden. This study aimed to prospectively compare multisystem symptoms, quality of life, and functioning in FAPDs with and without nausea. Adolescents ages 11-18years fulfilling Rome III criteria for a FAPD were grouped by the presence or absence of chronic nausea. Subjects completed validated instruments assessing nausea (Nausea Profile Questionnaire=NPQ), quality of life (Patient-Reported Outcome Measurement Information System), functioning (Functional Disability Inventory), and anxiety (State-Trait Anxiety Inventory for Children). Group comparisons were performed for instruments, multisystem symptoms, school absences, and clinical diagnoses. A total of 112 subjects were included; 71% reported chronic nausea. Patients with Nausea compared to No Nausea had higher NPQ scores (P≤0.001), worse quality of life (P=0.004), and greater disability (P=0.02). State and trait anxiety scores were similar (P=0.57, P=0.25). A higher NPQ score correlated with poorer quality of life, more disability, and higher anxiety. Specific comorbidities were more common in Nausea vs No Nausea group: dizziness (81% vs 41%; P≤0.001), concentrating difficulties (68% vs 27%; P≤0.001), chronic fatigue (58% vs 20%; P=0.01), and sleep disturbances (73% vs 48%; P=0.02). The Nausea group reported more school absences (P=0.001) and more commonly met criteria for functional dyspepsia (P=0.034). Nausea co-existing with FAPDs is associated with a higher extra-intestinal symptom burden, worse quality of life, and impaired functioning in children. Assessing and targeting nausea therapeutically is essential to improve outcomes in FAPDs.