Abdominal Pain in Patients with Gastroparesis: Associations with Gastroparesis Symptoms, Etiology of Gastroparesis, Gastric Emptying, Somatization, and Quality of Life

Abstract

Abdominal pain can be an important symptom in some patients with gastroparesis (Gp).

Aims: (1) To describe characteristics of abdominal pain in Gp; (2) describe Gp patients reporting abdominal pain.

Methods: Patients with idiopathic gastroparesis (IG) and diabetic gastroparesis (DG) were studied with gastric emptying scintigraphy, water load test, wireless motility capsule, and questionnaires assessing symptoms [Patient Assessment of Upper GI Symptoms (PAGI-SYM) including Gastroparesis Cardinal Symptom Index (GCSI)], quality of life (PAGI-QOL, SF-36), psychological state [Beck Depression Inventory (BDI), State-Trait Anxiety Index (STAI), PHQ-15 somatization scale].

Results: In total, 346 Gp patients included 212 IG and 134 DG. Ninety percentage of Gp patients reported abdominal pain (89% DG and 91% IG). Pain was primarily in upper or central midline abdomen, described as cramping or sickening. Upper abdominal pain was severe or very severe on PAGI-SYM by 116/346 (34%) patients, more often by females than by males, but similarly in IG and DG. Increased upper abdominal pain severity was associated with increased severity of the nine GCSI symptoms, depression on BDI, anxiety on STAI, somatization on PHQ-15, the use of opiate medications, decreased SF-36 physical component, and PAGI-QOL, but not related to severity of delayed gastric emptying or water load ingestion. Using logistic regression, severe/very severe upper abdominal pain associated with increased GCSI scores, opiate medication use, and PHQ-15 somatic symptom scores.

Conclusions: Abdominal pain is common in patients with Gp, both IG and DG. Severe/very severe upper abdominal pain occurred in 34% of Gp patients and associated with other Gp symptoms, somatization, and opiate medication use. ClinicalTrials.gov Identifier: NCT01696747.

Keywords: Abdominal pain; Diabetic gastroparesis; Gastroparesis; Idiopathic gastroparesis.

Figure 1.

Location of abdominal pain reported by the gastroparesis patients (combined diabetic and idiopathic etiologies). Shown are the percentages of patients reporting pain at each location. The abdominal pain was most commonly in upper middle (36%) or middle central (22%) abdominal locations.

Figure 2.

Severity levels of upper abdominal pain reported by the patients using the PAGISYM. Shown are the combined diabetic and idiopathic etiologies as well as the separate values for diabetic and idiopathic groups. Upper abdominal pain was rated as severe or very severe (score of 4 or 5) on PAGI-SYM by 116/346 (33.5%) patients and rated as moderate (score of 3) in another 79 patients (23%). Severe/very severe upper abdominal pain was similar in IG and DG (34% vs. 33%).