Factors related to abdominal pain in gastroparesis: contrast to patients with predominant nausea and vomiting

Abstract

Background Factors associated with abdominal pain in gastroparesis are incompletely evaluated and comparisons of pain versus other symptoms are limited. This study related pain to clinical factors in gastroparesis and contrasted pain/discomfort- with nausea/vomiting-predominant disease. Methods Clinical and scintigraphy data were compared in 393 patients from 7 centers of the NIDDK Gastroparesis Clinical Research Consortium with moderate-severe (Patient Assessment of Upper Gastrointestinal Disorders Symptoms [PAGI-SYM] score ≥3) vs. none-mild (PAGI-SYM <3) upper abdominal pain and predominant pain/discomfort vs. nausea/vomiting. Key Results Upper abdominal pain was moderate-severe in 261 (66%). Pain/discomfort was predominant in 81 (21%); nausea/vomiting was predominant in 172 (44%). Moderate-severe pain was more prevalent with idiopathic gastroparesis and with lack of infectious prodrome (P≤0.05) and correlated with scores for nausea/vomiting, bloating, lower abdominal pain/discomfort, bowel disturbances, and opiate and antiemetic use (P<0.05) but not gastric emptying or diabetic neuropathy or control. Gastroparesis severity, quality of life, and depression and anxiety were worse with moderate-severe pain (P≤0.008). Factors associated with moderate-severe pain were similar in diabetic and idiopathic gastroparesis. Compared to predominant nausea/vomiting, predominant pain/discomfort was associated with impaired quality of life, greater opiate, and less antiemetic use (P<0.01), but similar severity and gastric retention. Conclusions & Inferences Moderate-severe abdominal pain is prevalent in gastroparesis, impairs quality of life, and is associated with idiopathic etiology, lack of infectious prodrome, and opiate use. Pain is predominant in one fifth of gastroparetics. Predominant pain has at least as great an impact on disease severity and quality of life as predominant nausea/vomiting.

Clinical Presentation and Pathophysiology of Gastroparesis

“…10,35 Patient defined pain predominance was found in approximately 20% of patients referred to the NIDDK (National Institute of Diabetes and Digestive and Kidney Diseases) Gastroparesis Clinical Research Consortium. 10 Visceral hypersensitivity, defined as lowered threshold for eliciting visceral pain, is common among functional GI disorders, including functional dyspepsia and IBS. The presence of visceral hypersensitivity was found in 29% of patients with idiopathic gastroparesis 35 and 55% of patients with diabetic gastroparesis.…”

“…However, in a large multicenter cohort study, the prevalence of moderate-to-severe abdominal pain (approximately 60%) was similar between patients with idiopathic and diabetic gastroparesis. 10 In this study, 20% of patients with gastroparesis reported pain predominance compared with 44% reporting nausea/vomiting predominance. The presence of pain predominance was associated with decreased quality of life and increased depression and anxiety.…”

“…10 Abdominal pain often has been an overlooked symptom in patients with gastroparesis. Classical teaching dictates that patients with pain predominance should undergo additional evaluation for other causes.…”

Symptomatic Management for Gastroparesis

“…10 Nausea and/or vomiting represent the predominant symptoms, prompting specialist referral of 44% of patients ( Table 1). 11 In a single-center study, nausea scores averaged 3.4 (on a scale from 0 to 5) over 8 hours daily in patients with both diabetic and idiopathic gastroparesis. 10 Mean daily vomiting frequencies ranged from 3.5 with idiopathic disease to 7.3 for diabetics with gastroparesis.…”

Therapeutic Applications of Ghrelin Agonists in the Treatment of Gastroparesis

“…The clinical impact of gastroparesis is significant; symptoms, particularly pain, are associated with impaired quality of life and increased anxiety or depression [11] while examination of national trends has shown a > 200% increase in overall hospitalizations for gastroparesis [12]. There remains a need for development of effective and targeted pharmacologic treatments.…”