Psychological Dysfunction Is Associated With Symptom Severity but Not Disease Etiology or Degree of Gastric Retention in Patients With Gastroparesis

OBJECTIVES: 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. pi 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.