title: Bloating in gastroparesis: severity, impact, and associated factors.
abstract: OBJECTIVE
  Bloating is commonly reported in gastroparesis, but its prevalence, impact, and associated factors are uninvestigated. We aimed to quantify the prevalence of bloating in gastroparesis and relate its severity to clinical factors and quality of life.
  
  
  METHODS
  Survey, examination, and scintigraphy data were compared in 335 gastroparesis patients from 6 centers of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Gastroparesis Clinical Research Consortium. Bloating severity was stratified using Gastroparesis Cardinal Symptom Index (GCSI) bloating subscale scores.
  
  
  RESULTS
  Bloating severity of at least mild (GCSI ≥2) and severe (GCSI ≥4) grades were reported by 76 and 41% of patients, respectively. Bloating severity related to female gender (P<0.0001) and overweight status (P=0.04) on regression analysis and correlated with intensity of nausea, postprandial fullness, visible distention, abdominal pain, and altered bowel function (P<0.05). Disease etiology, smoking status, and gastric emptying did not relate to bloating subset (P>0.05). Disease-specific quality of life and general measures of well-being were progressively impaired with increasing bloating severity (P=0.01). Probiotic use (P=0.03) and use of antidepressants with significant norepinephrine reuptake inhibitor activity (P=0.045) use related to bloating severity; antiemetic use trended higher with worsening bloating (P=0.06).
  
  
  CONCLUSIONS
  Bloating is prevalent in gastroparesis and is severe in many individuals. Bloating severity relates to female gender, body weight, and intensity of other symptoms. The symptom impairs quality of life but is not influenced by gastric emptying rates. Antiemetics, probiotics, and antidepressants with significant norepinephrine reuptake inhibitor activity may affect reports of bloating. These findings provide insight into this underappreciated symptom of gastroparesis.
authors.affiliation: Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan 48109, USA. whasler@umich.edu
authors.forename: William L
authors.initials: WL
authors.lastname: Hasler
authors.forename: Laura A
authors.initials: LA
authors.lastname: Wilson
authors.forename: Henry P
authors.initials: HP
authors.lastname: Parkman
authors.forename: Linda
authors.initials: L
authors.lastname: Nguyen
authors.forename: Thomas L
authors.initials: TL
authors.lastname: Abell
authors.forename: Kenneth L
authors.initials: KL
authors.lastname: Koch
authors.forename: Pankaj J
authors.initials: PJ
authors.lastname: Pasricha
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: D034841:Abdominal Cavity / Q000503:physiopathology; D015746:Abdominal Pain / Q000209:etiology* / Q000503:physiopathology; D000328:Adult; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000009:adverse effects; D000932:Antiemetics / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005414:Flatulence / Q000209:etiology* / Q000503:physiopathology; D018589:Gastroparesis / Q000150:complications* / Q000503:physiopathology*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D009638:Norepinephrine / Q000037:antagonists & inhibitors; D050177:Overweight / Q000150:complications; D019936:Probiotics / Q000008:administration & dosage / Q000009:adverse effects; D011788:Quality of Life; D012720:Severity of Illness Index; D012737:Sex Factors
chemical_list: D000928:Antidepressive Agents; D000932:Antiemetics; D009638:Norepinephrine