Relationship of Symptoms to Quality of Life in Patients with Gastroparesis

Abstract

Purpose: Understanding symptom severity and the effects of symptoms on quality of life (QOL) in patients with gastroparesis may provide clinicians useful information to help guide treatment. The aim of this study was to identify specific gastrointestinal symptoms that most severely affect QOL in patients with gastroparesis. Methods: New patients with gastroparesis in 2006 were given the Patient Assessment of Upper Gastrointestinal Symptoms (PAGI-SYM) which evaluates symptom presence and severity using a 6-point Likert scale from 0 (none) to 5 (very severe) and the Patient Assessment of Upper Gastrointestinal Disorders-Quality Of Life (PAGI-QOL) questionnaire which covers five domains (daily activity, diet, psychological, clothing, relationship) and associates higher scores with worsening QOL with responses ranging from scale of 0–5. The PAGI-SYM questionnaire is a 20-item tool, which includes the 9 Gastroparesis Cardinal Symptom Index (GCSI) questionnaire. Results: During 2006, 53 new patients with gastroparesis were seen and filled out both questionnaires. The average age was 40 years, 42 patients were female (79%), and 17 patients had diabetic gastroparesis (32%). The GCSI score was 26.3 ± 1.2 and correlated with PAGI-QOL score (r = 0.47). The predominant symptom reported by the patients on the PAGI-SYM questionnaire was nausea (23 pts; 43%) followed by vomiting (13 pts; 25%) and abdominal pain (9 pts; 17%). Patients with vomiting as the predominant symptom had the highest (worse) QOL score (3.28 ± 0.25) when compared to nausea (3.01 ± 0.21, P= 0.41) and abdominal pain (2.99 ± 0.44, P= 0.55). Of the five QOL domains, the psychological QOL domain (3.68 ± 0.32) was highest in patients with vomiting as the predominant symptom, whereas the diet QOL domain was the highest in patients with the predominant symptom of nausea (3.61 ± 0.26) or abdominal pain (3.48 ± 0.32). In these patients with gastroparesis, the QOL questions associated with the worst QOL scores were: 1) Avoided certain types of food (4.13 ± 0.03); 2) Concern about what you can and cannot eat (4.11 ± 0.02); and 3) Frustrated about not being able to do what you wanted to do (4.06 ± 0.03). Conclusion: In patients with gastroparesis, although nausea was the most prevalent predominant symptom, vomiting was associated with the worst QOL score. Nausea and abdominal pain affected the diet domain, whereas vomiting affected psychological domain the most. Use of the PAGI-SYM and PAGI-QOL questionnaires helps to understand the impact of symptoms on quality of life in patients with gastroparesis.