Patient Assessment Of GI Symptoms Research Articles

Meal-eating characteristics among patients with symptoms of gastroparesis: Relationships to delays in gastric emptying.

Patients with symptoms of gastroparesis (Gp) often modify their diets and consume small meals. However, the relationship between patients' eating behavior and their gastric emptying is not well understood. This study describes meal-eating characteristics of patients with Gp symptoms and relates them to severity of emptying delay. Adult patients with Gp symptoms underwent 4-h gastric emptying scintigraphy and completed questionnaires including the Patient Assessment of GI Symptoms, a nutrition and diet questionnaire, and the Meal Patterns Questionnaire. Of 119 patients with Gp symptoms, 35 had normal gastric emptying (≤10% gastric retention at 4 h), 26 mildly delayed (>10%-20%), 28 moderately delayed (>20%-35%), and 30 severely delayed (>35%). Most patients (85%) reported eating small meals with an average of 2.4 meals per day. The most common reasons for stopping eating a meal were feeling full (83%), nausea (46%), and abdominal pain (31%). As gastric emptying worsened, patients increasingly made diet modifications such as low-fat, low-fiber, Gp diet, oral supplements, and blenderized meals (r = 0.309, p = 0.0007). Postprandial fullness lasted for 351 ± 451 min for patients with severely delayed emptying versus 207 ± 173 min for patients with normal emptying (p = 0.19). Meal-eating characteristics were found to vary with severity of gastric retention. Patients with severely delayed gastric emptying reported the longest duration of postprandial fullness. Dietary modification increased significantly with gastric retention. These meal-eating characteristics are important to understand as they impact on dietary education given to Gp patients for symptom management.

Evaluation of Gastrointestinal Symptoms in an ALS Cohort (P10-8.007)

<h3>Objective:</h3> The aim in this study is to understand the frequency of gastrointestinal symptoms in persons with ALS and relationship to disease duration and severity. <h3>Background:</h3> Amyotrophic Lateral Sclerosis is a disorder of motor neurons in which involvement of the enteric nervous system (ENS) has been implicated. Delayed gastric emptying and slowing of colonic transit time are reported. These symptoms impact the use of anticholinergic agents for treatments and offer opportunities for interventions that improve quality of life. <h3>Design/Methods:</h3> Patients diagnosed with ALS were recruited from the MDA/ALS Center of Hope Clinic at Temple University and healthy control volunteers were accepted. Patient Assessment of GI symptoms (GI-SYM) and Patient Assessment of Constipation (PAC-SYM) questionnaires are patient reported severity of symptoms over a 2-week history on an ordinal level. ALS Functional Rating Scale – Revised (ALSFRS-R), a 12-item questionnaire, assesses functional disability across 4 domains: bulbar, fine motor, gross motor and respiratory. Data was analyzed using IBM SPSS Statistics software. <h3>Results:</h3> 31 subjects are enrolled in the study with 12 controls and 19 ALS cases. The median(IQR) GI-SYM, PAC-SYM, and ALSFRS-R scores were 4.5(8), 1(4.75), and 42.5(15), respectively. A two-tailed t test, assuming unequal variances, revealed significant differences in PAC-SYM scores between healthy controls and ALS cases (t(23.22) = −2.17, p = 0.041). Spearman Rank Correlation revealed positive correlation between GI-SYM and PAC-SYM (r(26) = 0.70, p &lt; 0.001) and negative correlation between ALSFRS-R and GI-SYM (r(26) = −0.44, p = 0.019). <h3>Conclusions:</h3> In this preliminary study, the 2-week history GI-SYM questionnaire negatively correlated with ALSFRS-R scores and there was significant difference in PAC-SYM scores between healthy controls and ALS cases, suggesting potential enteric nervous system involvement. Recent evidence of brain-gut interaction, importance of the ENS, and the role of the microbiome in ALS and other neurodegenerative diseases suggests these symptoms are in part disease related. <b>Disclosure:</b> Dr. Empeno has nothing to disclose. Mr. Furey has nothing to disclose. Dr. Heiman-Patterson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for ITF. Dr. Heiman-Patterson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MTPA. Dr. Heiman-Patterson has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Samus. Dr. Heiman-Patterson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for MTPA. Dr. Heiman-Patterson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Heiman-Patterson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Amylym. Dr. Heiman-Patterson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biohaven. Dr. Heiman-Patterson has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cytokinetics.

Diabetes-related autoantibodies in diabetic gastroparesis.

Detection of islet autoantibodies [anti-glutamic acid decarboxylase antibody (GADA), anti-islet cell antibody (ICA), anti-insulin antibody (IAA)] in patients with diabetes usually indicates an autoimmune origin, suggesting type 1 diabetes (T1DM). The aim of our study was to determine whether islet autoantibodies are present in patients with diabetic gastroparesis and whether they associate with delayed gastric emptying, severity of GI symptoms, or diagnosed type of diabetes. Patients with diabetic gastroparesis completed: (1) Demographic Questionnaire assessing type of diabetes, associated symptoms and control of glucose and (2) Patient Assessment of GI Symptoms assessing symptoms severity. Blood was drawn for GADA, anti-islet cell ICA-IAA, and Hgb-A1c. Medical records were reviewed for gastric emptying tests and to confirm type of diabetes. Sixteen patients (12 T1DM; 4 diagnosed T2DM) with diabetic gastroparesis were evaluated. Six of the 16 patients tested positive for GADA, but none were positive for either ICA or IAA. Five of 12 T1DM patients had positive GADA, compared to one of four diagnosed as T2DM. The presence of antibodies was associated with the age of onset of gastroparesis symptoms, but not related to gastric emptying delay, symptom severity, HBA1c levels, or age. This pilot study demonstrated that of the three tested antibodies in long-term diabetic gastroparesis patients, GADA was the most prevalent positive antibody with no detection of ICA or IAA. Positive GADA was seen in 42 % of T1DM compared to 25 % of phenotypic T2DM. However, the presence of antibody was not associated with severity of gastric emptying or GI symptoms. Thus, detection of an autoimmune form of diabetes, primarily T1DM, should be investigated using GADA.

Cholecystectomy and Clinical Presentations of Gastroparesis

Many patients with gastroparesis have had their gallbladders removed. To determine if clinical presentations of patients with gastroparesis differ in those with prior cholecystectomy compared to patients who have not had their gallbladder removed. Gastroparetic patients were prospectively enrolled in the NIDDK Gastroparesis Registry. Detailed history and physical examinations were performed; patients filled out questionnaires including patient assessment of GI symptoms. Of 391 subjects with diabetic or idiopathic gastroparesis (IG), 142 (36 %) had a prior cholecystectomy at the time of enrollment. Patients with prior cholecystectomy were more often female, older, married, and overweight or obese. Cholecystectomy had been performed in 27/59 (46 %) of T2DM compared to 19/78 (24 %) T1DM and 96/254 IG (38 %) (p = 0.03). Patients with cholecystectomy had more comorbidities, particularly chronic fatigue syndrome, fibromyalgia, depression, and anxiety. Postcholecystectomy gastroparesis patients had increased health care utilization, and had a worse quality of life. Independent characteristics associated with prior cholecystectomy included insidious onset (OR = 2.06; p = 0.01), more comorbidities (OR = 1.26; p < 0.001), less severe gastric retention (OR(severe) = 0.68; overall p = 0.03) and more severe symptoms of retching (OR = 1.19; p = 0.02) and upper abdominal pain (OR = 1.21; p = 0.02), less severe constipation symptoms (OR = 0.84; p = 0.02), and not classified as having irritable bowel syndrome (OR = 0.51; p = 0.02). Etiology was not independently associated with a prior cholecystectomy. Symptom profiles in patients with and without cholecystectomy differ: postcholecystectomy gastroparesis patients had more severe upper abdominal pain and retching and less severe constipation. These data suggest that prior cholecystectomy is associated with selected manifestations of gastroparesis.

Assessment of symptoms during gastric emptying scintigraphy to correlate symptoms to delayed gastric emptying

Symptoms of gastroparesis based on patient recall correlate poorly with gastric emptying. The aim of this study is to determine if symptoms recorded during gastric emptying scintigraphy (GES) correlate with gastric emptying and with symptoms based on patient recall. Patients undergoing GES completed the Patient Assessment of GI Symptoms (PAGI-SYM) assessing symptoms over the prior 2 weeks and a questionnaire for which patients graded six symptoms during GES. A Symptom Severity Index (SSI) represented the mean of six symptoms at each time point. A total of 560 patients underwent GES for clinical evaluation of symptoms. Of 388 patients included in the study: 232 patients had normal GES (NGES), 156 delayed GES (DGES), and 11 rapid GES (RGES). Symptom severity index increased pre to postprandial for each group: NGES: 0.51 +/- 0.07 to 0.92 +/- 0.03, DGES: 0.60 +/- 0.09 to 1.13 +/- 0.05, and RGES: 0.56 +/- 0.12 to 0.79 +/- 0.13. Delayed gastric emptying scintigraphy patients had a higher postprandial SSI than NGES patients (1.13 +/- 0.05 vs 0.92 +/- 0.03, P < 0.05). Postprandial symptoms of stomach fullness (1.9 +/- 0.12 vs 1.5 +/- 0.09; P = 0.011), bloating (1.4 +/- 0.11 vs 1.1 +/- 0.09; P = 0.033), and abdominal pain (1.1 +/- 0.08 vs 0.7 +/- 0.12; P = 0.012) were higher in DGES than NGES. Symptom severity based on PAGI-SYM for 2 weeks prior to GES correlated with symptoms during the test for nausea (NGES, r = 0.61; DGES, r = 0.70), stomach fullness (NGES, r = 0.47; DGES, r = 0.60), and bloating (NGES, r = 0.62, DGES, r = 0.66). Stomach fullness, bloating, and abdominal pain recorded during GES were higher in patients with delayed gastric emptying than in patients with normal gastric emptying. Symptoms recorded during GES correlated with those during daily life by patient recall.