Su1432 Subjective Factors and Impact on Quality of Life in Patients With Gastroparesis

Abstract

Abdominal pain is seen in many patients with gastroparesis, but is not well characterized or recognized as a symptom of gastroparesis. Aims: 1) Describe characteristics of abdominal pain in gastroparesis; and 2) Determine differences in abdominal pain between diabetic (DG) and idiopathic gastroparesis (IG). Methods: Gastroparetic patients were enrolled at 8 centers into the NIH Gastroparesis Registry from September 2012 to October 2014. Patients had symptoms of gastroparesis for >12 weeks, delayed gastric emptying, negative endoscopy. History and physical examinations, questionnaires assessing symptoms (PAGI-SYM), quality of life (PAGI-QOL, SF-36), psychologic state (Beck Depression Inventory, State Trait Anxiety Index, PHQ-15), and a questionnaire characterizing abdominal pain were obtained. Results: 117 gastroparesis patients were enrolled: 74 IG, 40 DG, and 3 Post-Nissen. Overall, 92% of patients were experiencing abdominal pain. Abdominal pain was described as discomforting (38%) or distressing (27%), occurring every day in 52%, and most often localized in the upper middle portion of the abdomen (35% of patients) or middle central portion (19%). Abdominal pain worsened with eating in 52%, occurred at night (46%), and interfered with sleep (29%). Severity of upper abdominal pain, assessed by PAGI-SYM, was severe or very severe in 35% of patients, was more severe in females (p=0.001), and associated with decreased quality of life by PAGI-QOL (p=0.03) and SF-36 physical (p=0.11) and mental (p=0.10) components. Abdominal pain severity was associated with other symptoms of gastroparesis: nausea/vomiting subscale (p=0.03), early satiety/postprandial fullness subscale (p<0.001), and bloating subscale (p=0.002); but not gastric emptying. Abdominal pain severity was associated with other pain-related conditions, IBS (p=0.02) and migraine headaches (p=0.03), but not fibromyalgia. Upper abdominal pain was associated with increased PHQ-15 somatic symptom score (p=0.007), state anxiety (p=0.04), but not trait anxiety (p= 0.25) or depression (p=0.22). Upper abdominal pain severity was not significantly different between IG and DG (2.9±1.7 vs 2.5±1.7; p=0.30). Abdominal pain occurred with eating more often in IG (63 vs 35%; p<0.01) and was shorter duration in IG: less than one hour in 55% of IG vs 9% of DG; p=0.003. Upper abdominal pain severity was independently associated with female gender (OR 18.9; p=0.01), other gastroparesis symptoms (OR 2.8; p<0.001), and state anxiety score (OR=1.03; p=0.04). Conclusions: Abdominal pain is common in patients with gastroparesis, both idiopathic and diabetic. Upper abdominal pain severity is associated with decreased quality of life, female gender, anxiety and other gastroparesis symptoms. Thus, abdominal pain in gastroparesis patients needs understanding and treatment to reduce morbidity from this important symptom.