Characteristics of Nausea and Its Effects on Quality of Life in Diabetic and Idiopathic Gastroparesis

Aim: Nausea is a common symptom of gastroparesis (GP). The study is to determine the manifestations and impact of nausea in GP and to determine if there are any differences in diabetic (DG) and idiopathic gastroparesis (IG). Methods: The patients referred for GP symptoms underwent gastric emptying scintigraphy and completed the Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM), Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QOL), SF-36v2 Health-Related Quality-of-Life survey, and the Nausea Profile (NP). Results: Fifty-nine GP patients (20 diabetic, 39 idiopathic; 52 female; mean age 43 y) with delayed gastric emptying were enrolled. Nausea was an important symptom in these patients as assessed by PAGI-SYM (2.3 +/- 0.2) and it correlated with worse quality of life by PAGI-QOL (r = -0.299; P=0.021). The nausea and vomiting scores were similar in DG and IG, but DG had more severe retching (2.6 +/- 0.3 vs. 1.4 +/- 0.3; P=0.02) and more episodes of vomiting per week (4.4 +/- 1.4 vs. 3.5 +/- 1.3; P=0.037) compared with IG. Using the NP, total nausea scores in DG (61 +/- 3) were found to be greater than IG (49 (3; P=0.03) with somatic distress scores (60 +/- 5 vs. 44 +/- 4; P=0.03), and the gastrointestinal (GI) distress scores (84 +/- 4 vs. 73 +/- 4; P=0.05) were found to be greater in DG than IG. Although DG had slower gastric emptying than IG, there was no significant correlation between the NP scores and the degree of gastric retention on gastric emptying scintigraphy. Conclusions: Nausea and vomiting symptoms correlate with worse quality of life in GP patients. The DG patients experience greater nausea and increased somatic distress than IG. The differential perception of nausea in DG versus IG might be because of distinct pathophysiologic mechanisms.