Factors that contribute to the impairment of quality of life in gastroparesis

Authors: PARKMAN, HENRY - Temple University; WILSON, LAURA - Johns Hopkins University; YATES, KATHERINE - Johns Hopkins University; KOCH, KENNETH - Wake Forest University; ABELL, THOMAS - University Of Louisville; MCCALLUM, RICHARD - Texas Tech University Health Science Center; SAROSIEK, IRENE - Texas Tech University Health Science Center; KUO, BRADEN - Harvard Medical School; MALIK, ZUBAIR - Temple University; SCHEY, RON - Temple University; SHULMAN, ROBERT - Children'S Nutrition Research Center (CNRC); GROVER, MADHUSUDAN - Mayo Clinic; FARRUGIA, GIANRICO - Mayo Clinic; MIRIEL, LAURA - Johns Hopkins University; TONASCIA, JAMES - Johns Hopkins University; HAMILTON, FRANK - National Institute Of Diabetes And Digestive And Kidney Diseases; PASRICHA, PANKAJ - Johns Hopkins University

Submitted to: Neurogastroenterology & Motility
Publication Type: Peer Reviewed Journal
Publication Acceptance Date: 1/6/2021
Publication Date: 1/25/2021
Citation: Parkman, H.P., Wilson, L.A., Yates, K.P., Koch, K.L., Abell, T.L., McCallum, R.W., Sarosiek, I., Kuo, B., Malik, Z., Schey, R., Shulman, R.J., Grover, M., Farrugia, G., Miriel, L., Tonascia, J., Hamilton, F., Pasricha, P.J., For the NIDDK/NIH Clinical Gastroparesis Consortium. 2021. Factors that contribute to the impairment of quality of life in gastroparesis. Neurogastroenterology & Motility. https://doi.org/10.1111/nmo.14087.
DOI: https://doi.org/10.1111/nmo.14087

Interpretive Summary: Although it is recognized that inidiviudals with very slow stomach emptying (gastroparesis) have a quality of life that is poorer than healthy individuals, it is not clear what factors affect quality of life. In this study in adults we found that the number and severity of symptoms had a large impact on quality of life as did irritable bowel syndrome – a condition commonly associated with food intolerances. Nutritional strategies to address slow stomach emptying need to be evaluated in this age group as well as in children.

Technical Abstract: Understanding factors that impair quality of life (QOL) in gastroparesis is important for clinical management. Our aims were to: determine QOL in patients with gastroparesis and determine factors that impair QOL. Gastroparetic patients AQ6 underwent history and questionnaires assessing symptoms (PAGI-SYM and Rome III), QOL (SF-36v2 and PAGI-QOL), depression (Beck Depression Inventory [BDI]), and anxiety (State Trait Anxiety InventoryAQ7). 15 gastroparesis patients (256 diabetic (DG), 459 idiopathic (IG)) were evaluated. SF-36 physical component (PC) score averaged 33.3 +/- 10.5; 41% had impaired score <30. SF-36 PC scores were similar between diabetic and idiopathic gastroparesis. Impaired SF-36 PC associated with increased nausea/vomiting and upper abdominal pain subscores, acute onset of symptoms, higher number of comorbidities, use of narcotic pain medications, and irritable bowel syndrome (IBS). SF-36 mental component (MC) score averaged 38.9 +/- 13.0; 26% had impaired score <30. Poor SF-36 MC associated with diabetic etiology, higher Beck depression inventory, and state anxiety scores. PAGI-QOL score averaged 2.6 +/- 1.1; 50% had a score of <2.6. Low PAGI-QOL associated with higher fullness, bloating, and upper abdominal pain subscores, more depression and Trait anxiety, smoking cigarettes, need for nutritional support, progressively worsening symptoms and periodic exacerbations. Multiple measures show poor QOL present in gastroparesis. Several areas impacted on reduced QOL: Symptoms of nausea, vomiting, and abdominal pain, as well as IBS; Etiology and acute onset and progressively worsening symptoms; Comorbidities and psychological factors such as anxiety and depression; Patient-related factors such as smoking. Targeting the modifiable factors may improve patient outcomes in gastroparesis.