title: A novel classification scheme for gastroparesis based on predominant-symptom presentation.
abstract: OBJECTIVE
  Symptoms of gastroparesis are very diverse. Classifying patients by predominant symptom may improve management strategy.
  
  
  OBJECTIVE
  To validate a new symptom-predominant classification for gastroparesis using symptom severity and quality-of-life measures.
  
  
  METHODS
  Subjects with gastroparesis for >2 months were prospectively enrolled. A physician classified each subject into one of the following: vomiting-predominant, dyspepsia-predominant, or regurgitation-predominant gastroparesis. Subjects also classified themselves independently from the physician. Each subject completed a Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) and SF-12v2 Health-Related Quality-Of-Life survey. Receiver operating characteristic curves were constructed with sensitivity and specificity of each PAGI-SYM subscale to differentiate subjects into symptom-predominant subgroups. Area under the curve (AUC) was used to compare the receiver operating characteristic curves. Analysis of variance, Cohen's kappa (kappa) statistic, student t test, and Pearson correlation (r) were used.
  
  
  RESULTS
  One hundred subjects (87 females, mean 48 y) were enrolled. There was a 78% concordance between physician and subject's classification of gastroparesis with substantial correlation (kappa=0.64). PAGI-SYM nausea/vomiting subscale (AUC=0.79) and PAGI-SYM heartburn/regurgitation subscale (AUC=0.73) were the best in differentiating subjects into vomiting-predominant and regurgitation-predominant gastroparesis, respectively. No subscale was adequate to differentiate dyspepsia-predominant gastroparesis. SF-12v2 total scores significantly correlated with worsening of the total PAGI-SYM scores (r=-0.339 to -0.600, all P<0.001).
  
  
  CONCLUSIONS
  There was a substantial agreement between physician and patient using a symptom-predominant gastroparesis classification. Results suggest that a predominant-symptom classification is a valid means to categorize subjects with vomiting-predominant and regurgitation-predominant gastroparesis. Patients with dyspepsia and delayed gastric emptying need further research.
authors.affiliation: Division of Gastroenterology/Hepatology, University of Louisville School of Medicine, Louisville, KY 40202, USA. steven.harrell@louisville.edu
authors.forename: Steven P
authors.initials: SP
authors.lastname: Harrell
authors.forename: Jamie L
authors.initials: JL
authors.lastname: Studts
authors.forename: Gerald W
authors.initials: GW
authors.lastname: Dryden
authors.forename: Jennifer
authors.initials: J
authors.lastname: Eversmann
authors.forename: Luwa
authors.initials: L
authors.lastname: Cai
authors.forename: John M
authors.initials: JM
authors.lastname: Wo
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D016099:Endoscopy, Gastrointestinal; D005260:Female; D005746:Gastric Emptying / Q000502:physiology; D018589:Gastroparesis / Q000145:classification* / Q000175:diagnosis / Q000503:physiopathology; D006356:Heartburn / Q000175:diagnosis* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012372:ROC Curve; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires