title: Gastrointestinal symptoms in patients with liver cirrhosis: associations with nutritional status and health-related quality of life.
abstract: OBJECTIVE
  Gastrointestinal symptoms can lead to decreased food intake and thereby increased morbidity. There is a general lack of data on the prevalence of gastrointestinal symptoms and their potential association with malnutrition and health-related quality of life (QoL) in cirrhosis. Our aim was to prospectively evaluate gastrointestinal symptoms, malnutrition, and QoL in patients with cirrhosis.
  
  
  METHODS
  Two validated questionnaires were used to measure gastrointestinal symptoms (gastrointestinal symptom rating scale (GSRS)) and health-related QoL (SF-36) in 128 consecutive cirrhotics (mean age 57 years, Child-Pugh score 8.6, MELD score 13.2) at a tertiary referral center. The results were compared with those of controls from the general population. Nutritional status was assessed by anthropometry and estimation of recent weight change.
  
  
  RESULTS
  Compared to controls, cirrhotic patients showed higher gastrointestinal symptom severity (total GSRS score: 1.53, 95% CI 1.50-1.55 versus 2.21, 95% CI 2.04-2.38) and profound reductions in the SF-36 physical (47.0 95% CI 45.0-49.0 versus 37.9, 95% CI 35.7-40.1) and mental component summary scores (51.0 95% CI 49.0-53.0 versus 39.2 95% CI 36.7-41.6). There were no significant differences in any GSRS domain between patients with and those without malnutrition. Multivariate analysis showed that gastrointestinal symptom severity was associated with the Child-Pugh score (beta = 0.10, r<0.05), daily lactulose use (beta = 0.65, p<0.005), and the presence of gastrointestinal comorbidities (beta = 0.51, p<0.05). Negative weight change (beta = -0.72, p<0.05) and the SF-36 physical (beta = -4.26, p<0.005) and mental (beta = -4.53, p<0.005) summaries were independently related to gastrointestinal symptom severity.
  
  
  CONCLUSIONS
  Patients with cirrhosis show increased severity of gastrointestinal symptoms, which are associated with recent weight loss and impaired health-related QoL. The severity of gastrointestinal symptoms seems to be related to the severity of cirrhosis.
authors.affiliation: Section of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden. evangelos.kalaitzakis@vgregion.se
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kalaitzakis
authors.forename: Magnus
authors.initials: M
authors.lastname: Simrén
authors.forename: Rolf
authors.initials: R
authors.lastname: Olsson
authors.forename: Pia
authors.initials: P
authors.lastname: Henfridsson
authors.forename: Irene
authors.initials: I
authors.lastname: Hugosson
authors.forename: Maria
authors.initials: M
authors.lastname: Bengtsson
authors.forename: Einar
authors.initials: E
authors.lastname: Björnsson
mesh_terms: D005260:Female; D005767:Gastrointestinal Diseases / Q000503:physiopathology*; D006801:Humans; D008103:Liver Cirrhosis / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009752:Nutritional Status; D011446:Prospective Studies; D011788:Quality of Life; D011795:Surveys and Questionnaires