title: Psychological dysfunction is associated with symptom severity but not disease etiology or degree of gastric retention in patients with gastroparesis.
abstract: OBJECTIVE
  Gastroparesis patients may have associated psychological distress. This study aimed to measure depression and anxiety in gastroparesis in relation to disease severity, etiology, and gastric retention.
  
  
  METHODS
  Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI) scores for state (Y1) and trait (Y2) anxiety were obtained from 299 gastroparesis patients from 6 centers of the National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium. Severity was investigator graded as grades 1, 2, or 3 and patient reported by Gastroparesis Cardinal Symptom Index (GCSI) scores. Antiemetic/prokinetic medication use, anxiolytic and antidepressant medication use, supplemental feedings, and hospitalizations were recorded. BDI, Y1, and Y2 scores were compared in diabetic vs. idiopathic etiologies and mild (≤20%) vs. moderate (>20-35%) vs. severe (>35-50%) vs. very severe (>50%) gastric retention at 4 h.
  
  
  RESULTS
  BDI, Y1, and Y2 scores were greater with increasing degrees of investigator-rated gastroparesis severity (P<0.05). BDI, Y1, and Y2 scores were higher for GCSI >3.1 vs. ≤3.1 (P<0.05). Antiemetic and prokinetic use and ≥6 hospitalizations/year were more common with BDI ≥20 vs. <20 (P<0.05). Anxiolytic use was more common with Y1≥46; antidepressant use and ≥6 hospitalizations/year were more common with Y2≥44 (P<0.05). BDI, Y1, and Y2 scores were not different in diabetic and idiopathic gastroparesis and did not relate to degree of gastric retention. On logistic regression, GCSI >3.1 was associated with BDI ≥20 and Y1≥46; antiemetic/prokinetic use was associated with BDI≥20; anxiolytic use was associated with Y1≥46; and antidepressant use was associated with Y2≥44.
  
  
  CONCLUSIONS
  Higher depression and anxiety scores are associated with gastroparesis severity on investigator- and patient-reported assessments. Psychological dysfunction does not vary by etiology or degree of gastric retention. Psychological features should be considered in managing gastroparesis.
authors.affiliation: Department of Gastroenterology, University of Michigan, Ann Arbor, Michigan 48109, USA. whasler@umich.edu
authors.forename: William L
authors.initials: WL
authors.lastname: Hasler
authors.forename: Henry P
authors.initials: HP
authors.lastname: Parkman
authors.forename: Laura A
authors.initials: LA
authors.lastname: Wilson
authors.forename: Pankaj J
authors.initials: PJ
authors.lastname: Pasricha
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Koch
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Abell
authors.forename: William J
authors.initials: WJ
authors.lastname: Snape
authors.forename: Gianrico
authors.initials: G
authors.lastname: Farrugia
authors.forename: Linda
authors.initials: L
authors.lastname: Lee
authors.forename: James
authors.initials: J
authors.lastname: Tonascia
authors.forename: Aynur
authors.initials: A
authors.lastname: Unalp-Arida
authors.forename: Frank
authors.initials: F
authors.lastname: Hamilton
mesh_terms: D000328:Adult; D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D005260:Female; D005746:Gastric Emptying; D018589:Gastroparesis / Q000209:etiology / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires