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Delayed Gastric Emptying Doesn’t Affect Quality of Life in Dyspeptic Patients

Identifying a common physiologic abnormality that affects quality of life is difficult, even in a population with similar symptoms.

The contribution of delayed gastric emptying to symptoms and quality of life in patients with functional dyspepsia is unclear. To address this issue, investigators studied 864 patients with postprandial symptoms of functional dyspepsia who were recruited for four different studies of tegaserod therapy.

At the time of inclusion in the study, all patients underwent scintigraphic gastric-emptying studies after standard meals. Patients with gastric residuals of >6.3% after 4 hours were considered to have delayed gastric emptying. Symptom severity and predominant symptoms were determined by using a Likert scale, health-related quality of life (HRQOL) was determined by using the SF-36 questionnaire, and disease-specific quality of life was measured by using the Nepean Dyspepsia Index (NDI). The HRQOL findings for patients with and without delayed gastric emptying were compared.

Only 290 patients (34%) had delayed gastric emptying. A weak association was seen between postprandial fullness and delayed gastric emptying (odds ratio, 1.98; 95% CI, 1.02–3.86). No correlation was found between other symptoms (abdominal pain, nausea, bloating, early satiety) and impaired gastric emptying. Overall HRQOL scores (as measured by the mean score for each domain on the SF-36) in dyspepsia patients were significantly lower than standard normal scores. Mean physical composite score (PCS) and mental composite score (MCS) also were lower (42.3 and 46.8, compared with a standard normal score of 50). Although female sex, fullness, pain, and nausea correlated with lower PCS scores, delayed gastric emptying did not. Female sex, epigastric pain, and nausea (but not delayed gastric emptying) were significantly associated with lower NDI scores.

The authors concluded that delayed gastric emptying is associated only weakly with symptoms in patients who have postprandial functional dyspepsia. The mean HRQOL score in this population is lower than that in healthy adults, but this difference is not explained by delayed gastric emptying.

Comment: Functional dyspepsia likely is caused by a variety of physiologic changes. Distinguishing different types of dyspepsia based on the predominant symptom, as suggested by the Rome criteria, often is difficult. These findings demonstrate that, even when a specific patient population (those with postprandial symptoms) is studied, identifying a common physiologic abnormality that explains such symptoms or the effect on quality of life is difficult.

— David J. Bjorkman, MD, MSPH (HSA), SM (Epid.)

Published in Journal Watch Gastroenterology September 29, 2006

Citation(s):

Talley NJ et al. Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut 2006 Jul; 55:933-9.

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