Digestive Diseases and Sciences
Rome IV Diagnostic Questionnaire Complements Patient Assessment
of Gastrointestinal Symptoms for Patients with Gastroparesis
· Henry P. Parkman
Received: 8 February 2018 / Accepted: 16 May 2018
© Springer Science+Business Media, LLC, part of Springer Nature 2018
Background Patient assessment of upper gastrointestinal symptoms (PAGI-SYM) questionnaire assesses severity of gastroin-
testinal symptoms in gastroparesis (Gp), dyspepsia, and gastroesophageal reﬂux disease. Rome IV Diagnostic Questionnaire
(R4DQ), used to diagnose various functional gastrointestinal disorders, may also help to better understand symptoms of Gp.
Aim To assess patients with Gp comparing PAGI-SYM to R4DQ.
Methods Patients with symptoms of Gp referred to our center from May 2016 to January 2018 ﬁlled out PAGI-SYM and
Results Out of 357 patients, 225 had delayed gastric emptying including 121 with idiopathic gastroparesis (IGp), 60 with
diabetic gastroparesis (DGp), 25 with atypical Gp, and 19 with postsurgical gastroparesis (PSGp). Using PAGI-SYM, DGp
had more severe retching and vomiting compared to IGp. PSGp had more severe upper abdominal pain compared to IGp.
Using R4DQ, the average number of Rome IV diagnoses that Gp patients met criteria was 2.1 ± 0.1. Most Gp patients had
functional dyspepsia (n = 197, 90.8%) and chronic nausea and vomiting syndrome (CNVS) (n = 181, 83.4%). Postprandial
distress syndrome (PDS) was present in 189 patients (88.3%), and epigastric pain syndrome in 126 patients (59.8%). The
combination of PDS and CNVS was seen in 76.5% of Gp patients.
Conclusions In this study, Gp patients were characterized using the PAGI-SYM and R4DQ. DGp had more severe retch-
ing and vomiting, while PSGp had more severe upper abdominal pain. PDS and CNVS were the most prevalent Rome IV
diagnoses. The combination of PDS and CNVS was typically seen in patients with Gp. R4DQ can be helpful to characterize
Keywords Gastroparesis · Functional dyspepsia · Postprandial distress syndrome · Epigastric pain syndrome · Chronic
nausea and vomiting syndrome · Rome IV Diagnostic Questionnaire · Patient assessment of upper gastrointestinal
Patients with gastroparesis (Gp) can have a variety of gastro-
intestinal (GI) symptoms that frequently impair the quality
of their lives [1, 2]. These chronic symptoms include nausea,
vomiting, early satiety, postprandial fullness, abdominal dis-
tension, and abdominal pain [1, 2]. The two most common
subtypes of Gp are idiopathic gastroparesis (IGp) and dia-
betic gastroparesis (DGp) . Less frequently, patients can
have Gp postsurgically, or in atypical cases associated with
other disorders, including connective tissue and neuromus-
cular diseases . Diﬀerent subtypes of Gp often present
with similar GI symptoms. Characterizing Gp patients and
subtypes of Gp based on their symptomology can help in the
management of Gp.
Patient Assessment of Gastrointestinal Symptoms (PAGI-
SYM) is a validated questionnaire for assessing severity of
GI symptoms in Gp, dyspepsia, and gastroesophageal reﬂux
disease (GERD) . The PAGI-SYM, which includes the
Gastroparesis Cardinal Symptom Index (GCSI), is often
used to characterize symptoms in Gp (1,3).
* Henry P. Parkman
Section of Gastroenterology, Department of Medicine,
Temple University School of Medicine, 3401 North Broad
Street, Philadelphia, PA 19140, USA