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Functional Dyspepsia: Clinical Symptoms, Psychological Findings, and GCSI Scores

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Abstract

Background

The GCSI questionnaire measures symptoms of gastroparesis (GP). Symptoms of FD overlap with GP. The ability of the GCSI to discriminate FD from GP is unknown.

Aims

By prospectively evaluating functional dyspepsia (FD) patients, we aimed to evaluate the ability of the Gastroparesis Cardinal Symptom Index (GCSI) to: (1) distinguish FD from GP; (2) predict symptom severity, anxiety, and depression; (3) correlate symptoms with gastric emptying.

Methods

FD patients (Rome III criteria) were identified, and upper endoscopy and gastric emptying scan (GES) data recorded. A total of 254 patients were mailed a questionnaire evaluating demographics, FD symptoms, mental well-being; the GCSI was included.

Results

One hundred and twenty-three patients responded; of them, 75% were women and mean age was 49 (15 SD) years. 44.7% were categorized as postprandial distress subtype (PDS), 34.1% were epigastric pain subtype (EPS), and 21.1% were mixed type. The mean GCSI score was 2.02 (1.1 SD), slightly lower than historical GP controls (2.26–2.56). Mixed EPS–PDS subtype had the lowest GCSI scores (1.79; 0.91 SD). Bloating was the highest GCSI subscore (2.70; 1.53 SD), followed by fullness (2.31; 1.39 SD) and nausea (1.08; 1.19 SD). The GCSI total score did not correlate with anxiety and depression scores or with 4-h gastric emptying.

Conclusions

In this population of FD patients, GCSI scores were slightly lower than historical gastroparesis control patients, although within the reported range. These results suggest that the GCSI cannot accurately distinguish FD patients from GP patients. A more specific questionnaire is needed to aid in the diagnosis and management of these distinct gastrointestinal disorders.

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References

  1. Jung H, Choung RS, Locke GR III, et al. The incidence, prevalence, and outcomes of patients with gastroparesis, in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225–1233.

    Article  PubMed  Google Scholar 

  2. Rey E, Choung RS, Schleck CD, Zinsmeister AR, Talley NJ, Locke GR III. Prevalence of hidden gastroparesis in the community: the gastroparesis “iceberg”. J Neurogastroenterol Motil. 2012;18:34–42.

    Article  PubMed  PubMed Central  Google Scholar 

  3. El-Serag HB, Talley NJ. Systematic review: the prevalence and clinical course of functional dyspepsia. Aliment Pharmacol Ther. 2004;19:643–654.

    Article  CAS  PubMed  Google Scholar 

  4. Stanghellini V, Chan FKL, Hasler WL, et al. Gastroduodenal disorders. Gastroenterology. 2016;150:1380–1392.

    Article  PubMed  Google Scholar 

  5. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108:18–37.

    Article  CAS  PubMed  Google Scholar 

  6. Lacy BE. Functional dyspepsia and gastroparesis: One disease or two? Am J Gastroenterol. 2012;107:1615–1620.

    Article  PubMed  Google Scholar 

  7. Talley NJ, Young L, Bytzer P, et al. Impact of chronic gastrointestinal symptoms in diabetes mellitus on health-related quality of life. Am J Gastroenterol. 2001;96:71–76.

    Article  CAS  PubMed  Google Scholar 

  8. Talley NJ, Locke GR, Lahr BD, et al. Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut. 2006;55:933–939.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Parkman HP, Camilleri M, Farrugia G, et al. Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting. Neurogastroenterol Motil. 2010;22:113–133.

    Article  CAS  PubMed  Google Scholar 

  10. Lacy BE, Weiser KT, Kennedy AT, Crowell MD, Talley NJ. Functional dyspepsia: the economic impact to patients. Aliment Pharmacol Ther. 2013;38:170–177.

    Article  CAS  PubMed  Google Scholar 

  11. Lacy BE, Crowell MD, Mathis C, Bauer D, Heinberg LJ. Gastroparesis: quality of life and healthcare utilization. J Clin Gastroenterol. 2018;52:20–24.

    PubMed  Google Scholar 

  12. Parkman HP, Hasler WL, Fisher RS, et al. For the American Gastroenterological Association. American Gastroenterological Association medical position statement: diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1589–1591.

    Article  PubMed  Google Scholar 

  13. Hoogerwerf WA, Pasricha PJ, Kalloo AN, et al. Pain: the overlooked symptom in gastroparesis. Am J Gastroenterol. 1999;94:1029–1033.

    Article  CAS  PubMed  Google Scholar 

  14. Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95:1456–1462.

    Article  CAS  PubMed  Google Scholar 

  15. Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology. 2011;140:101–115.

    Article  PubMed  Google Scholar 

  16. Grover M, Bernard C, Pasricha P, et al. Clinical-histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium. Neurogastroenterol Motil. 2012;24:e249–531.

    Google Scholar 

  17. Tack J, Carbone F, Rotondo A. Gastroparesis. Curr Opin Gastroenterol. 2015;31:499–505.

    Article  CAS  PubMed  Google Scholar 

  18. Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology. 2004;127:1239–1255.

    Article  PubMed  Google Scholar 

  19. Tack J, Talley NJ, Camilleri M, et al. Functional gastroduodenal disorders. Gastroenterology. 2006;130:1466–1479.

    Article  PubMed  Google Scholar 

  20. Lacy BE, Talley NJ, Locke GR 3rd, et al. Review article: current treatment options and management of functional dyspepsia. Aliment Pharmacol Ther. 2012;36:3–15.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Stanghellini V, Tosetti C, Paternicò A, et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology. 1996;110:1036–1042.

    Article  CAS  PubMed  Google Scholar 

  22. Sarnelli G, Caenepeel P, Geypens B, Janssens J, Tack J. Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia. Am J Gastroenterol. 2003;98:783–788.

    Article  PubMed  Google Scholar 

  23. Kayyam U, Sachdeva P, Gomez J, et al. Assessment of symptoms during gastric emptying scintigraphy to correlate symptoms to delayed gastric emptying. Neurogastroenterol Motil. 2010;22:539–545.

    Google Scholar 

  24. Janssen P, Harris MS, Jones M, et al. The relation between symptom improvement and gastric emptying in the treatment of diabetic and idiopathic gastroparesis. Am J Gastroenterol. 2013;108:1382–1391.

    Article  CAS  PubMed  Google Scholar 

  25. Vanheel H, Carbone F, Valvekens L, et al. Pathophysiological abnormalities in functional dyspepsia subgroups according to the Rome III criteria. Am J Gastroenterol. 2017;112:132–140.

    Article  CAS  PubMed  Google Scholar 

  26. Revicki DA, Rentz AM, Dubois D, et al. Gastroparesis Cardinal Symptom Index (GCSI): development and validation of a patient reported assessment of severity of gastroparesis symptoms. Qual Life Res. 2004;13:833–844.

    Article  PubMed  Google Scholar 

  27. Rentz A, Kahrilas P, Stanghellini V, et al. Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders. Qual Life Res. 2004;13:1737–1749.

    Article  CAS  PubMed  Google Scholar 

  28. Olausson EA, Störsrud S, Grundin H, et al. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol. 2014;109:375–385.

    Article  CAS  PubMed  Google Scholar 

  29. Pasricha PJ, Colvin R, Yates K, et al. Characteristics of patients with chronic unexplained nausea and vomiting and normal gastric emptying. Clin Gastroenterol Hepatol. 2011;9:567–576.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Friedenberg FK, Palit A, Parkman HP, Hanlon A, Nelson DB. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103:416–423.

    Article  CAS  PubMed  Google Scholar 

  31. Revicki DA, Camilleri M, Kuo B, et al. Evaluating symptom outcomes in gastroparesis clinical trials: validity and responsiveness of the Gastroparesis Cardinal Symptom Index-Daily Diary (GCSI-DD). Neurogastroenterol Motil. 2012;24:456–463.

    Article  CAS  PubMed  Google Scholar 

  32. Cassilly DW, Wang YR, Friedenberg FK, et al. Symptoms of gastroparesis: use of the Gastroparesis Cardinal Symptom Index in symptomatic patients referred for gastric emptying scintigraphy. Digestion. 2008;78:144–151.

    Article  PubMed  Google Scholar 

  33. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67:361–370.

    Article  CAS  PubMed  Google Scholar 

  34. Farup CE, Leidy NK, Murray M, et al. Effect of domperidone on the health-related quality of life of patients with symptoms of diabetic gastroparesis. Diabetes Care. 1998;21:1699–1706.

    Article  CAS  PubMed  Google Scholar 

  35. Bell RA, Jones-Vessey K, Summerson JH. Hospitalizations and outcomes for diabetic gastroparesis in North Carolina. South Med J. 2002;95:1297–1299.

    Article  PubMed  Google Scholar 

  36. Wang YR, Fisher RS, Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol. 2008;103:313–322.

    Article  PubMed  Google Scholar 

  37. Lacy BE, Everhart K, Crowell MD. Functional dyspepsia is associated with sleep disorders. Clin Gastroenterol Hepatol. 2011;9:410–414.

    Article  PubMed  Google Scholar 

  38. Talley NJ, Locke GR, Saito YA, et al. Effect of amitriptyline and escitalopram on functional dyspepsia: a multicenter, randomized controlled study. Gastroenterology. 2015;149:340–349.

    Article  CAS  PubMed  Google Scholar 

  39. Tack J, Bisschops R, Sarnelli G. Pathophysiology and treatment of functional dyspepsia. Gastroenterology. 2004;127:1239–1255.

    Article  PubMed  Google Scholar 

  40. Talley NJ, Verlinden M, Jones M. Validity of a new quality of life scale for functional dyspepsia: A United States multicenter trial of the Nepean Dyspepsia Index. Am J Gastroenterol. 1999;94:2390–2397.

    Article  CAS  PubMed  Google Scholar 

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Acknowledgment

The authors would like to thank the patients at the Dartmouth-Hitchcock Medical Center who kindly filled out the detailed questionnaire.

Funding

No external funding was provided for this study. The study was personally funded by the P.I.

Author information

Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Brian E. Lacy

  2. Division of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

    Kelly Everhart

  3. Mayo Clinic, Scottsdale, AZ, USA

    Michael D. Crowell

Authors
  1. Brian E. Lacy
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  2. Kelly Everhart
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  3. Michael D. Crowell
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Contributions

BEL, KE, and MDC all equally contributed to the design of the study, interpretation of the data, and writing and editing of the manuscript. No outside support was provided to help with data interpretation, data analysis, or writing or editing of the manuscript. None of the authors have any relevant disclosures pertinent to this manuscript.

Corresponding author

Correspondence to Brian E. Lacy.

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None of the authors have any conflicts of interest to disclose with regard to the production of this manuscript.

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Lacy, B.E., Everhart, K. & Crowell, M.D. Functional Dyspepsia: Clinical Symptoms, Psychological Findings, and GCSI Scores. Dig Dis Sci 64, 1281–1287 (2019). https://doi.org/10.1007/s10620-018-5347-2

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  • DOI: https://doi.org/10.1007/s10620-018-5347-2

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