Psychological controversies in gastroparesis: A systematic review

Table 3 General recommendations and questions for future research

General recommendations:

Identify prevalence of psychological conditions based upon standardized and validated assessment tools (e.g., SCID[37], MINI[38])

Use standardized assessment of gastroparesis (e.g., gastric emptying scintigraphy, PAGI-SYM[39])

Use validated psychological scales to assess, anxiety, depression, stress (e.g., BDI[40], BAI[41], STAI[42], DASS[43]) and QoL measures relevant to individuals with upper gastrointestinal disorders (e.g., PAGI-QoL[44])

Use and provide clear scoring information

Report assessment results in a manner that allows comparison across studies (e.g., standardized cut-off scores)

Psychological interventions:

Randomized control trial design

Prior to intervention, power analyses conducted

Clear details of intervention content made fully available to allow other researchers to review and undertake accurate replication

Gastroparesis-focused interventions

Include measures that assess a cost/benefit analysis, engagement of medical services

Where possible, patients, assessors, and statistician blinded

Independent evaluation of intervention session recordings to ensure protocol/treatment consistency

Psychological interventions need to be clearly identified and undertaken by trained and appropriately qualified individuals (i.e., psychologists, psychiatrists)

Identify clear inclusion and exclusion criteria

Identifying if (and where possible control for) participants have/have not received or are currently receiving psychotherapy (including type, duration etc.), using psychotropic medication, are on specialized diets for their gastroparesis

Utilize valid measures which can be accurately compared to other intervention studies

Evaluate participant engagement in therapy (e.g., % attendance to sessions, completion of homework)

Evaluate differences between completers versus non-completers

Include long-term post-therapy efficacy review time points (i.e., 1 and 2 yr post-intervention)

Future research questions:

What is the prevalence of psychopathology in gastroparesis compared to other gastroenterological cohorts?

What psychological processes act as moderating/mediating factors between gastroparesis symptom activity and outcome variables such as QoL, anxiety, and depression (e.g., personality, coping style, self-efficacy)?

How may gender impact upon the presentation and course of gastroparesis and associated psychological distress?

How may historical and current stressors and/or traumas impact upon the presentation and course of gastroparesis?

To what extent does duration of symptoms/disease influence the relationship between gastroparesis and psychological distress?

QoL: Quality of life.