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Severity levels of upper abdominal pain reported by the patients using the PAGI-SYM. 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%)
Source publication
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,...
Citations
... The absence of standardized criteria to refer patients for a GE test can lead to another selection bias since this decision was made according to the clinician's decision. Moreover, there was no evaluation of symptoms not included in the GCSI score, especially abdominal pain which is a very common symptom in GP.41 ...
Background
The association between upper gastrointestinal symptoms and delayed gastric emptying (GE) shows conflicting results. This study aimed to assess whether the symptoms of the Gastroparesis Cardinal Symptom Index (GCSI) and/or the scores were associated with the result of GE tests and whether they could predict delayed GE.
Methods
Patients referred for suspected gastroparesis (GP) were included in a prospective database. Demographical data, medical history, and symptoms of the GCSI score were collected for each patient. A GE scintigraphy was then performed with a 4‐hour recording. Delayed GE was defined as a retention rate ≥ 10% at 4 h.
Results
Among 243 patients included in this study, 110 patients (45%) had delayed GE. The mean age (49.9 vs. 41.3 years; p < 0.001) and weight loss (9.4 kg vs. 5.6 kg; p = 0.025) were significantly higher in patients with delayed GE. Patients with diabetes or a history of surgery had a higher prevalence of delayed GE (60% and 78%, respectively) than patients without comorbidity (17%; p < 0.001). The GCSI score was higher in patients with delayed GE (3.06 vs. 2.80; p = 0.045), but no threshold was clinically relevant to discriminate between patients with normal and delayed GE. Only vomiting severity was significantly higher in patients with delayed GE (2.19 vs. 1.57; p = 0.01).
Conclusion
GE testing should be considered when there are symptoms such as a higher weight loss, comorbidities (diabetes, and history of surgery associated with GP), and the presence of vomiting. Other symptoms and the GCSI score are not useful in predicting delayed GE.
... 5 The patient's quality of life and productivity may be significantly affected by DGP, which can also have a significant financial and indirect social impact on society and healthcare providers. 6 Diabetes causes irregular gastric emptying patterns by changing the motor activity of distinct parts of the stomach. Glucosestimulated or glucose-inhibited neurons in the stomach inhibitory and gastric excitatory vagal circuits are impacted by abrupt changes in blood sugar levels, which results in altered gastric emptying. ...
... 26 (5) In the pyloric region of the colon and the stomach, respectively, the ICC of submucosa and submucosal plexus are located at the interface between the submucosal connective tissue and the innermost circular muscle layer. 27 (6) The connective tissue below the mesothelium contains ICC-SS, which are stellate, multi-processed cells. These cells are organized along the axis of the longitudinal muscle fibers in the proximal colon and form an electrical network via intercellular gap junctions. ...
Diabetic gastroparesis (DGP) is a common complication of diabetes mellitus, marked by gastrointestinal motility disorder, a delayed gastric emptying present in the absence of mechanical obstruction. Clinical manifestations include postprandial fullness and epigastric discomfort, bloating, nausea, and vomiting. DGP may significantly affect the quality of life and productivity of patients. Research on the relationship between gastrointestinal dynamics and DGP has received much attention because of the increasing prevalence of DGP. Gastrointestinal motility disorders are closely related to a variety of factors including the absence and destruction of interstitial cells of Cajal, abnormalities in the neuro-endocrine system and hormone levels. Therefore, this study will review recent literature on the mechanisms of DGP and gastrointestinal motility disorders as well as the development of prokinetic treatment of gastrointestinal motility disorders in order to give future research directions and identify treatment strategies for DGP.
... Наукові дослідження останніх років виявили, що рівень глюкози залежно від величини може сповільнювати або пришвидшувати випорожнення шлунка. З огляду на це можна дійти висновку, що діабетична гастропатія є одним із предикторів розвитку ГЕРХ на тлі ЦД [10,14]. ...
Objective — to reveal the features of the clinical course in patients with gastroesophageal reflux disease (GERD) depending on anthropometric indicators against the background of type 2 diabetes mellitus (DM2). Materials and methods. The study involved 100 patients, who were divided into 3 groups: group 1 consisted of 60 patients with DM2 in combination with GERD, group 2 included 20 patients with isolated GERD, and group 3 included DM2 patients. The patients of group 1 were additionally divided into 2 subgroups: 27 subjects with normal weight and 33 subjects with excessive body weight (EBW) or obesity of various degrees. The control group consisted of 20 practically healthy people. The distribution of patients by gender and age was carried out in accordance with the standards of the international classification of age periods of the World Health Organization, revised in 2015. From the total number of patients, 44 (44%) were men and 56 (56%) were women. Body mass index (BMI) was calculated according to the Quetelet formula. Endoscopic examination of the upper part of the gastrointestinal tract with targeted biopsy was performed with an esophagogastroduodenoscope with end optics «Olympus GIF Q 15003» (manufacturer Olympus Europa SE & CO. KG, Japan). To increase the diagnostic value of esophagogastroduodenoscopy, methods of chromoscopy and pinch biopsy of the esophageal mucosa were used. Results. Comparison of GERD manifestations with account of anthropometric data revealed significant differences in the subgroups with normal weight and obesity (p <0.05). Gastroenterological complaints were not registered in 6 (26.1%) patients of the obesity subgroup (DM2 + GERD + obesity) and 8 (21.6%) patients of the non‑obese subgroup (DM2 + GERD). In the subgroup with obesity (DM2 + GERD + obesity), the significant differences (p <0.001) were detected in heartburn depending on the obesity stage. Heartburn in this subgroup occurred 7.4 times more often than in patients with normal weight compared to the subgroup without obesity (odds ratio 89.13% (95%CI 12.83—137.77) χ2=35.06; р <0.0001). Cardiac symptoms in patients with increased body weight were revealed 12.3 times more often vs. subjects with BMI less than 25 kg/m2 (odds ratio 5.0 (95% CI 1.58 ‑14.10); χ2=6.95; р=0.008). The presence of heartburn complaints at the 2nd stage of obesity (39±5 kg/m2) and its absence at normal body mass (28±2 kg/m2), p <0.001) have been established. Analysis of the dependence of the Helicobacter pylori contamination degree on the BMI value showed no statistically significant differences between the subgroups with normal body weight and subgroup with EBW and obesity. The highest contamination degree was found in group 1 (DM2 + GERD) with the same number of positive results in both subgroups, with and without obesity. Conclusions. It has been established that excessive body weight and obesity significantly affect the development and progression of gastroenterological complaints in patients with DM2 combined with GERD. The heartburn was more often registered in patients with DM2 with obesity, than in those with normal weight. Comparison of GERD findings with anthropometric data revealed significant differences between the subgroups with normal body weight and obesity (р <0.05). Heartburn in the obesity subgroup occurred 7.4 times more often.
... Abdominal pain is the most common gastrointestinal symptom with a heavy burden of healthcare-associated costs [1]. Though not extensively explored, the prevalence of abdominal pain has been reported in up to 90% of patients with gastroparesis in various studies, like that of nausea and vomiting [2]. Though gastric emptying study (GES) is a helpful indicator for diagnosing Gp, many patients have similar symptoms despite normal GES and are clustered under the umbrella of Gastroparesis-like syndromes (GLS). ...
... Abdominal pain is a predominant symptom in patients with Gp and GLS with a significant impact on quality of life (QoL) [3]. Roughly, two-thirds of the patients have reported moderate abdominal pain in studies, while one-third have reported constant abdominal pain [2,4]. The Gastroparesis Cardinal Symptom Index (GCSI), which was designed to quantify the severity of Gp symptoms, interestingly does not include abdominal pain as one of the symptoms [5]. ...
The prevalence of abdominal pain in gastroparesis ranges from 42 to 89%. Severe/very severe abdominal pain is often correlated with somatization, psychiatric conditions, and opioid use and affects the quality of life significantly. Treatment of abdominal pain in gastroparesis is complex and based on pathophysiology: phenotypes and endotypes of gastroparesis. However, the pathophysiology of gastroparesis itself is not clearly known, which makes its treatment more intriguing. In this article, we reviewed details of the pathophysiology and treatment modalities of abdominal pain in gastroparesis.
Advances in electrogastrogram technology such as high-resolution electrogastrogram are evolving to categorize the overlapping symptom profiles. There is emerging data about full-thickness gastric biopsy findings to understand the pathophysiologic changes in gastroparesis, but its clinical implications on management decisions are yet to be explored. Bioelectric procedures and endoscopic and surgical techniques for refractory gastroparesis have been relatively new areas of research interest. Despite reassuring results in some research studies, abdominal pain relief by those invasive therapeutic modalities needs to be further investigated through large clinical trials with both short-term and long-term follow-up of therapeutic efficacy and complications.
Management of abdominal pain-predominant gastroparesis and gastroparesis-like syndromes are challenging, similar to chronic pain management; however, due to its potential significant impact on quality of life, further research is warranted to explore the individualized treatment options based on the pathophysiology of gastroparesis and gastroparesis-like syndromes.
... Abdominal pain is another prominent symptom that requires evaluation (22% of cases). GP patients with abdominal pain have been found to exhibit elevated somatization scores on the Patient Health Questionnaire (PHQ-15 and PHQ−12, p < 0.001), as well as higher levels of depression (p < 0.001) and anxiety (p = 0.01) [44]. Treating abdominal pain in GP can be challenging [45,46]. ...
Gastroparesis (GP) is a chronic disease characterized by upper gastrointestinal symptoms, primarily nausea and vomiting, and delayed gastric emptying (GE), in the absence of mechanical GI obstruction. The underlying pathophysiology of GP remains unclear, but factors contributing to the condition include vagal nerve dysfunction, impaired gastric fundic accommodation, antral hypomotility, gastric dysrhythmias, and pyloric dysfunction. Currently, gastric emptying scintigraphy (GES) is considered the gold standard for GP diagnosis. However, the overall delay in GE weakly correlates with GP symptoms and their severity. Recent research efforts have focused on developing treatments that address the presumed underlying pathophysiological mechanisms of GP, such as pyloric hypertonicity, with Gastric Peroral Endoscopic Myotomy (G-POEM) one of these procedures. New promising diagnostic tools for gastroparesis include wireless motility capsule (WMC), the 13 carbon-GE breath test, high-resolution electrogastrography, and the Endoluminal Functional Lumen Imaging Probe (EndoFLIP). Some of these tools assess alterations beyond GE, such as muscular electrical activity and pyloric tone. These modalities have the potential to characterize the pathophysiology of gastroparesis, identifying patients who may benefit from targeted therapies. The aim of this review is to provide an overview of the current knowledge on diagnostic pathways in GP, with a focus on the association between diagnosis, symptoms, and treatment.
... In a recent prospective study of 346 GP patients (212 idiopathic) whose symptoms were assessed by numerous questionnaires and who underwent various physiologic tests (such as GES and WMC), abdominal pain was found to be present in 90% of patients. 74 Further, abdominal pain was found to be more common in women, and over 50% of patients reported daily pain. Moreover, over one-third of patients reported severe or very severe pain, and pain severity was associated with depression, anxiety, and elevated somatic symptom scores. ...
Gastroparesis (GP), a historically vexing disorder characterized by symptoms of nausea, vomiting, abdominal pain, early satiety, and/or bloating, in the setting of an objective delay in gastric emptying, is often difficult to treat and carries a tremendous burden on the quality of patients’ lives, as well as the healthcare system in general. Though the etiology of GP has been fairly well defined, much work has been done recently to better understand the pathophysiology of GP, as well as to identify novel effective and safe treatment options. As our understanding of GP has evolved, many myths and misconceptions still abound in this rapidly changing field. The goal of this review is to identify myths and misconceptions regarding the etiology, pathophysiology, diagnosis, and treatment of GP, in the context of the latest research findings which have shaped our current understanding of GP. Recognition and dispelling of such myths and misconceptions is critical to moving the field forward and ultimately advancing the clinical management of what will hopefully become a better understood and more manageable disorder in the future.
... 14 Abdominal pain as a common symptom, especially in cases of idiopathic gastroparesis, but is often overlooked. 15 In one study, vomiting more often prompted evaluation for diabetic gastroparesis. In contrast, abdominal pain, early satiety, and postprandial fullness were more common in idiopathic gastroparesis. ...
Gastroparesis is defined by delayed gastric emptying in the absence of mechanical obstruction of the stomach. Patients experience symptoms of nausea, vomiting, abdominal pain, fullness and early satiety. The recognition of the disorder has progressed due to availability of gastric emptying scintigraphy and advancements made in understanding its pathophysiology and treatment options. The clinical presentation and treatment of gastroparesis overlaps with a more commonly recognized disorder of gut-brain interaction, functional dyspepsia. Recent studies have reenergized the discussion whether these two are separate entities or perhaps reflect a spectrum of gastroduodenal neuromuscular disorders. The societal guidelines conflict on the utility of gastric emptying scintigraphy in assessment of patients with upper gastrointestinal symptoms. A better appraisal of similarities and differences between gastroparesis and functional dyspepsia will allow targeted treatment for these disorders. This is particularly important as specific pharmacological and endoscopic treatment options are being developed for gastroparesis which are unlikely to be helpful for funcational dyspepsia. This review makes the case for considering these disorders in a spectrum where identification of both would most ideally position us towards providing the optimal clinical care.
... Personal performance is significantly reduced at work and during leisure time (3). A correlation between abdominal discomfort and decreased quality of life in affected individuals is well evidenced in gastroenterology (4,5). ...
Background/aim:
Abdominal discomfort during tumour therapy often leads to the use of phytotherapeutics from the field of folk medicine. What knowledge base do patients and young physicians have when they come across this phenomenon together?
Patients and methods:
We conducted an online survey of 157 medical students and, in consultation, 125 patients according to a standardised algorithm about their knowledge and use of a list of given medicinal plants for the above-mentioned symptomatology. We previously created the list of traditional German medicinal plants taking into account the symptoms of bloating, fullness, diarrhoea, constipation, and nausea. Both data pools are presented descriptively, compared using principal component analysis, and student knowledge was subjected to network analysis.
Results:
As a median, patients know 9 medicinal plants and use 4 species. Students know 10 medicinal plants and use 5 species. The rate of non-users is 13.6% among patients and 11.4% among students. The plants used by both groups are ginger and mint, whereas patients also use camomile and fennel. The nearly coincident knowledge profile speaks of a common knowledge base - folk medicine. Network analysis illustrated that students stored their knowledge in symptom clusters.
Conclusion:
Patients with cancer and students are familiar with a similar canon of medicinal plants for the treatment of abdominal discomfort. Their common source is folk medicine. Targeted instructions on evidence-based phytotherapy are needed to improve students' existing symptom-cluster-related knowledge.
... Despite the major quality of life impact of these symptoms, treatment of the symptoms can be difficult and the identification of the underlying causes may be challenging. Refractory abdominal pain in the setting of chronic nausea and vomiting is reported in gastroparesis and is similarly impactful with over one-third of patients reporting severe abdominal pain [5]. Because of the wellestablished gastrointestinal side effects of narcotic analgesics, management of this pain adds an additional layer of clinical complexity to an already difficult predicament [6]. ...
... The combination of chronic nausea, vomiting, and refractory abdominal pain in patients with gastroparesis and gastroparesis-like symptoms and normal gastric emptying posits a significant management challenge given the paucity of effective therapies combined with the devastating toll these symptoms have on patients. Approximately twothirds of patients with gastroparesis experience moderateto-severe abdominal pain and this has a negative effect on their quality of life [1,2,5]. Our results suggest that SCS could prove to be an alternative to currently available drug or device therapies for patients with chronic nausea, vomiting, and refractory abdominal pain. ...
Background
Patients with chronic nausea and vomiting often also have chronic abdominal pain. Spinal cord stimulation (SCS) may provide pain control, but scarce data are available regarding the effect of SCS on chronic nausea and vomiting.AimsWe aimed to determine the effect of SCS in patients with chronic nausea, vomiting, and refractory abdominal pain.Methods
Retrospective chart review of 26 consecutive patients who underwent SCS trial for a primary diagnosis of nausea, vomiting and refractory abdominal pain.Results26 patients underwent SCS trial, with an average age of 48 years. Twenty-three patients (88.5%) reported > 50% pain relief during the temporary SCS trial and then underwent permanent implantation. Patients were then followed for 41 (22–62) months. At baseline, 20 of the 23 patients (87.0%) reported daily nausea, but at 6 months and the most recent follow-up, only 8 (34.8%) and 7 (30.4%) patients, respectively, had daily nausea (p < 0.001). Days of nausea decreased from 26.3 days/month at baseline to 12.8 and 11.7 days/month at 6 months and at the most recent visit, respectively. Vomiting episodes decreased by 50%. Abdominal pain scores improved from 8.7 to 3.0 and 3.2 at 6 months and the most recent visit, respectively (both p < 0.001). Opioid use decreased from 57.7 mg MSO4 equivalents to 24.3 mg at 6 months and to 28.0 mg at the latest patient visit (both p < 0.05).ConclusionsSCS may be an effective therapy for long-term treatment of symptoms for those patients afflicted with chronic nausea, vomiting, and refractory abdominal pain.
... We found no reports of persons with hemochromatosis who also had diabetes and gastroparesis. In 134 patients with gastroparesis attributed to diabetes, 89% had abdominal pain, especially epigastric pain, although none was described to have hemochromatosis [73]. ...
Background
In hemochromatosis, causes of abdominal pain and its associations with cirrhosis are poorly understood.
Methods
We retrospectively compared characteristics of referred hemochromatosis probands with HFE p.C282Y homozygosity with/without biopsy-proven cirrhosis: sex, age, diabetes, heavy alcohol consumption, abdominal pain/tenderness, hepatomegaly, splenomegaly, non-alcoholic fatty liver disease, chronic viral hepatitis, ascites, transferrin saturation (TS), serum ferritin (SF), and iron removed by phlebotomy (QFe). We performed logistic regression on cirrhosis using characteristics identified in univariate comparisons. We performed computerized and manual searches to identify hemochromatosis case series and compiled prevalence data on cirrhosis and abdominal pain and causes of abdominal pain.
Results
Of 219 probands, 57.1% were men. Mean age was 48±13 y. In 22 probands with cirrhosis, proportions of men, mean age, prevalences of heavy alcohol consumption, abdominal pain, abdominal tenderness, hepatomegaly, splenomegaly, and chronic viral hepatitis, and median TS, SF, and QFe were significantly greater than in probands without cirrhosis. Regression analysis revealed three associations with cirrhosis: abdominal pain (p = 0.0292; odds ratio 9.8 (95% CI: 1.2, 76.9)); chronic viral hepatitis (p = 0.0153; 11.5 (95% CI: 1.6, 83.3)); and QFe (p = 0.0009; 1.2 (95% CI: 1.1, 1.3)). Of eight probands with abdominal pain, five had cirrhosis and four had diabetes. One proband each with abdominal pain had heavy alcohol consumption, chronic viral hepatitis B, hepatic sarcoidosis, hepatocellular carcinoma, and chronic cholecystitis, cholelithiasis, and sigmoid diverticulitis. Abdominal pain was alleviated after phlebotomy alone in four probands. In 12 previous reports (1935–2011), there was a negative correlation of cirrhosis prevalence and publication year (p = 0.0033). In 11 previous reports (1935–1996), a positive association of abdominal pain prevalence and publication year was not significant (p = 0.0802).
Conclusions
Abdominal pain, chronic viral hepatitis, and QFe are significantly associated with cirrhosis in referred hemochromatosis probands with HFE p.C282Y homozygosity. Iron-related and non-iron-related factors contribute to the occurrence of abdominal pain.
