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Purpose: GI dysmotility is prevalent in about 90% of SSc patients, increasing patient morbidity and in some cases mortality. Previous studies have demonstrated gastric dysmotility in SSc patients, by increased bradygastria and tachygastria and decreased gastric wave coupling using surface electrogastrography (EGG) measuring gastric myoelectrical activity (GMA). We assessed GMA and its possible correlations to GI symptoms and overall perceived functioning in SSc patients from the Genetics vs Environment in Systemic Sclerosis (GENISOS) Cohort.
Methods: 17 SSc patients were enrolled and underwent fasting four channel surface EGG. Channels 1-4 reflect the corpus (1), antrum (2, 3) and pylorus (4) of the stomach. EGG also records gastric wave coupling, which reflects the coordination of gastric regions during peristalsis. Demographic data were collected and patients completed questionnaires designed by us inquiring to upper and lower GI symptoms (by symptom presence, frequency, quality of life (QOL) impact by y/n and VAS 1-100 cm), called the Gastrointestinal Diseases Questionnaire (GIDQ) and validated instruments of MOS SF-36 and Interpersonal Support Evaluation List (ISEL). Statistical Analysis: The EGG, GI symptoms SF-36 and ISEL collected above were analyzed by the Pearson product-moment correlation. p values <0.05 were considered significant.
Results: GMA and GIDQ scores: There were significant correlations with upper GI symptoms (swallowing liquids, swallowing solids, hoarseness, chest pain, heartburn, abdominal pain) and GMA bradygastria, tachygastria and arrhythmias (individually analyzed, mean values: r2=0.90 and p<0.001). Abdominal bloating significantly correlated to gastric wave coupling (r2=0.31, p<0.02). Frequency of nausea, vomiting, diarrhea and constipation symptoms also significantly correlated to GMA. Limitations in work and social activities and awakening at night secondary to abdominal pain or also significantly correlated to gastric wave coupling (r2=0.25, 0.3 and 0.90, p< 0.03, 0.02, and 0.001 respectively). GMA and SF-36 scores: There were significant correlations between gastric wave coupling (channel 3, 4, and channels 2, 4) and SF-36 scores (general health r2=0.57, p<0.02 and emotional r2=0.55, p<0.02, respectively). GMA and ISEL scores: Significant correlations were noted between ISEL scores and channel 4 gastric arrhythmias (r2=0.42, p<0.02).
Conclusion: GI symptoms, quality of life issues and perceived functioning significantly correlated with gastric myoelectrical activity, which has been shown to reflect gastric dysmotility in SSc patients. This study demonstrates that GI symptoms and QOL issues correlate with gastric dysmotility as measured by surface EGG. It also supports the need for validated questionnaires that will accurately identify GI pathology, patient functioning and quality of life issues secondary to GI involvement.
Methods: 17 SSc patients were enrolled and underwent fasting four channel surface EGG. Channels 1-4 reflect the corpus (1), antrum (2, 3) and pylorus (4) of the stomach. EGG also records gastric wave coupling, which reflects the coordination of gastric regions during peristalsis. Demographic data were collected and patients completed questionnaires designed by us inquiring to upper and lower GI symptoms (by symptom presence, frequency, quality of life (QOL) impact by y/n and VAS 1-100 cm), called the Gastrointestinal Diseases Questionnaire (GIDQ) and validated instruments of MOS SF-36 and Interpersonal Support Evaluation List (ISEL). Statistical Analysis: The EGG, GI symptoms SF-36 and ISEL collected above were analyzed by the Pearson product-moment correlation. p values <0.05 were considered significant.
Results: GMA and GIDQ scores: There were significant correlations with upper GI symptoms (swallowing liquids, swallowing solids, hoarseness, chest pain, heartburn, abdominal pain) and GMA bradygastria, tachygastria and arrhythmias (individually analyzed, mean values: r2=0.90 and p<0.001). Abdominal bloating significantly correlated to gastric wave coupling (r2=0.31, p<0.02). Frequency of nausea, vomiting, diarrhea and constipation symptoms also significantly correlated to GMA. Limitations in work and social activities and awakening at night secondary to abdominal pain or also significantly correlated to gastric wave coupling (r2=0.25, 0.3 and 0.90, p< 0.03, 0.02, and 0.001 respectively). GMA and SF-36 scores: There were significant correlations between gastric wave coupling (channel 3, 4, and channels 2, 4) and SF-36 scores (general health r2=0.57, p<0.02 and emotional r2=0.55, p<0.02, respectively). GMA and ISEL scores: Significant correlations were noted between ISEL scores and channel 4 gastric arrhythmias (r2=0.42, p<0.02).
Conclusion: GI symptoms, quality of life issues and perceived functioning significantly correlated with gastric myoelectrical activity, which has been shown to reflect gastric dysmotility in SSc patients. This study demonstrates that GI symptoms and QOL issues correlate with gastric dysmotility as measured by surface EGG. It also supports the need for validated questionnaires that will accurately identify GI pathology, patient functioning and quality of life issues secondary to GI involvement.
T.A. McNearney, None; S.E. Hunnicutt, None; D. Doshi, None; J.D. Chen, None.