Brief Article
Copyright ©2009 The WJG Press and Baishideng. All rights reserved.
World J Gastroenterol. Dec 28, 2009; 15(48): 6052-6060
Published online Dec 28, 2009. doi: 10.3748/wjg.15.6052
Different faces of gastroparesis
Klaus Bielefeldt, Naeem Raza, Susan L Zickmund
Klaus Bielefeldt, Naeem Raza, Division of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States
Susan L Zickmund, Center of Health Equity Research and Practice at the Veteran Administration Health System Pittsburgh, Pittsburgh, PA 15213, United States
Author contributions: Bielefeldt K designed and conducted the study, analyzed the data and was responsible for the drafting and final approval of the manuscript; Raza N was involved in study design, recruited patients, performed data entry and participated in drafting of the manuscript; Zickmund SL supervised the qualitative data acquisition and analysis.
Correspondence to: Klaus Bielefeldt, MD, PhD, Division of Gastroenterology, University of Pittsburgh Medical Center, 200 Lothrop St., Pittsburgh, PA 15213, United States.
Telephone: +1-412-3836731 Fax: +1-412-6489378
Received: July 1, 2009
Revised: August 25, 2009
Accepted: September 1, 2009
Published online: December 28, 2009

AIM: To test the hypothesis that pain and affect rather than impaired emptying determine symptom severity in patients with gastroparesis.

METHODS: Adult patients with documented gastroparesis were enrolled prospectively in a single center and asked to complete the Gastroparesis Cardinal Symptom Index (GCSI), Hospital Anxiety and Depression Scale (HADS), the Short Form 12 (SF-12) as quality of life index, rate pain severity and answer 10 open-ended questions.

RESULTS: A total of 55 patients (44 women) participated. Idiopathic (n = 29) or diabetic (n = 11) gastroparesis and connective tissue disease (n = 8) were the most common underlying causes. Antiemetics (n = 30) and prokinetics (n = 32) were most often prescribed. Seventeen patients used opioids on a daily basis. Nausea and/or vomiting (n = 28), pain (n = 24) and bloating (n = 14) were most commonly listed as dominant symptoms. Patients subjectively attributed symptom improvement to nutritional and dietary therapy (n = 11), prokinetics (n = 11), antiemetics (n = 10) or analgesic agents (n = 3). In univariate analyses, the physical subscore of the SF-12 and HADS, but not gastric emptying delay or symptom duration significantly correlated with disease severity as measured by the GCSI. In multivariate analyses, the combination of vomiting, bloating and depression best predicted the overall impact on quality of life.

CONCLUSION: The study confirms the importance of pain and affect in gastroparesis, which requires novel approaches to improve more effectively the quality of life in patients with this disorder.

Keywords: Pain, Depression, Gastroparesis, Quality of life