Gastrointestinal Symptom Distress is Associated With Worse Mental and Physical Health-Related Quality of Life.
The prevalence of self-reported gastrointestinal (GI) symptoms and distress is high, but few studies have quantified their impact on health-related quality of life (HRQoL).



We conducted a prospective cohort study of patients with HIV in care in Ontario, Canada (2007-2014). General linear mixed models were used to assess the impact of GI symptoms (diarrhea/soft stool, nausea/vomiting, bloating/painful abdomen, loss of appetite, weight loss/wasting) and distress (range: 0-4) on physical and mental HRQoL summary scores (range: 0-100) measured by the Medical Outcomes Survey SF-36.



A total of 1787 participants completed one or more questionnaires {median 3 [interquartile range (IQR): 1-4]}. At baseline, 59.0% were men who had sex with men, 53.7% white, median age 45 (IQR: 38-52), median CD4 count 457 (IQR: 315-622), and 71.0% had undetectable HIV viremia. The mean (standard deviation [SD]) mental and physical HRQoL scores were 49.2 (8.6) and 45.3 (13.0), respectively. In adjusted models, compared with those reporting no symptoms, all GI symptom distress scores from 2 ("have symptom, bothers me a little") to 4 ("have symptom, bothers a lot") were associated with lower mental HRQoL. Loss of appetite distress scores ≥ 1; scores ≥ 2 for diarrhea, nausea/vomiting, and bloating; and a score ≥ 3 for weight loss were independently associated with lower physical HRQoL scores (P < 0.0001). Increasing GI symptom distress is associated with impaired mental and physical HRQoL (P < 0.0001).



Increasing GI symptom distress is associated with impaired mental and physical HRQoL. Identifying, treating, and preventing GI symptoms may reduce overall symptom burden and improve HRQoL for patients with HIV.
*Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; †Ontario HIV Treatment Network, Toronto, Ontario, Canada; ‡Toronto General Research Institute, University Health Network, Toronto, Ontario, Canada; §Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada; ‖Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; ¶Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada; #Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; **Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; ††Department of Psychology, Ryerson University, Toronto, Ontario, Canada; ‡‡Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada; and §§Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
Tyler J
TJ
OʼNeill
Janet M
JM
Raboud
Jill
J
Tinmouth
Sean B
SB
Rourke
Sergio
S
Rueda
Trevor A
TA
Hart
Curtis
C
Cooper
Anita
A
Rachlis
Ann N
AN
Burchell
D000328:Adult; D000368:Aged; D005767:Gastrointestinal Diseases / Q000473:pathology* / Q000523:psychology*; D015658:HIV Infections / Q000150:complications*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario; D010809:Physical Fitness; D011446:Prospective Studies; D011788:Quality of Life / Q000523:psychology*