Observational Study
Copyright ©The Author(s) 2016.
World J Gastroenterol. Oct 28, 2016; 22(40): 8978-8990
Published online Oct 28, 2016. doi: 10.3748/wjg.v22.i40.8978
Table 1 Structure of postgastrectomy syndrome assessment scale-45
DomainsSubdomainsItemsSubscales
QOLSF-8 (QOL)1Physical functioning1Five or six-point Likert scalePhysical component summary1
2Role physical1Mental component summary1
3Bodily pain1
4General health1
5Vitality1
6Social functioning1
7Role emotional1
8Mental health1
SymptomsGSRS9Abdominal painsSeven-point Likert scaleEsophageal reflux subscale (item 10, 11, 13, 24)
symptoms10HeartburnExcept item 29 and 32Abdominal pain subscale (item 9, 12, 28)
11Acid regurgitationMeal-related distress subscale (item 25-27)
12Sucking sensations in the epigastriumIndigestion subscale (item 14-17)
13Nausea and vomitingDiarrhea subscale (item 19, 20, 22)
14BorborygmusConstipation subscale (item 18, 21, 23)
15Abdominal distensionDumping subscale (item 30, 31, 33)
16Nausea and vomiting
17Increased flatusTotal symptom scale (above seven subscales)
18Decreased passage of stools
19Increased passage of stools
20Loose stools
21Hard stools
22Urgent need for defecation
23Feeling of incomplete evacuation
PGSAS original24Bile regurgitation
symptoms25Sense of foods sticking
26Postprandial fullness
27Early satiation
28Lower abdominal pains
29Number and type of early dumping symptoms
30Early dumping general symptoms
31Early dumping abdominal symptoms
32Number and type of late dumping symptoms
33Late dumping symptoms
Living statusMeals (amount) 134Ingested amount of food per meal1-
35Ingested amount of food per day1
36Frequency of main meals
37Frequency of additional meals
Meals (quality)38Appetite1Five-point Likert scaleQuality of ingestion subscale1 (item 38-40)
39Hunger feeling1
40Satiety feeling1
Meals (amount) 241Necessity for additional mealsFive-point Likert scale-
Social activity42Ability for workingFive-point Likert scale-
QOLDissatisfaction (QOL)43Dissatisfaction with symptomsFive-point Likert scaleDissatisfaction for daily life subscale (item 43-45)
44Dissatisfaction at the meal
45Dissatisfaction at working
Table 2 Postgastrectomy syndrome assessment scale original items English version
PGSAS-45 is consisting of SF-8 (item 1-8), GSRS (item 9-23) and PGSAS original items (item 24-45)
24Have you been bothered by bile regurgitation (having a bitter taste in your mouth) during the past month?
25Have you been bothered by sense of foods sticking when swallowing during the past month? (Sticking food refers to uncomfortable feeling with foods piled up in the chest.)
26Have you been bothered by postprandial fullness during the past month? (Fullness refers to uncomfortable or heavy feeling with foods piled up in the stomach.)
27Have you been bothered by being unable to eat enough because you feel full before you finish your meal during the past month?
28Have you been bothered by circumumbilical pains or lower abdominal pains during the past month?
29Have you experienced following symptoms around 30 min after eating during the past month? Please encircle the number that describes your symptom. (Please check all the symptoms you have experienced.)
(Ans. Q29)
1. No symptoms below
[You have experienced following general symptoms.]
2. Cold sweat 3. Palpitations 4. Dizziness 5. Numbness 6. Fainting 7. Facial flushing
8. Facial pallor 9. Feeling hot 10. Fatigue or weakness 11. Lassitude 12. Drowsiness
13. Headache 14. Heaviness of the head 15. Tightness in the chest
[You have experienced following abdominal symptoms.]
16. Borborygmi (except after drinking milk) 17. Abdominal cramps (except after drinking milk)
18. Diarrhoea (except after drinking milk) 19. Nausea 20. Vomiting 21. Bloating
22. Abdominal discomfort
30For those who encircled any of the general symptom-related items in Question 29, to what extent have you been bothered by all these general symptoms during the past month?
31For those who encircled any of the abdominal symptom-related items in Question 29, to what extent have you been bothered by all these abdominal symptoms during the past month?
32Have you experienced following symptoms within two to three hours after eating during the past month? Please circle the number that describes your symptom. (Please check all the symptoms you have experienced.)
(Ans. Q32)
1. No symptoms below
[You have experienced following general symptoms.]
2. Cold sweat 3. Palpitations 4. Dizziness 5. Headache 6. Fainting 7. Fatigue or weakness
8. Lassitude 9. Languor 10. Shakiness 11. Hunger 12. Shortness of breath
33For those who encircled any of the general symptom-related items in Question 32, to what extent have you been bothered by all these general symptoms during the past month?
(Ans. Q24-28, 30 ,31, 33)
1. No discomfort at all 2. Slight discomfort 3. Mild discomfort 4. Moderate discomfort
5. Moderately severe discomfort 6. Severe discomfort 7. Very severe discomfort
34On average what percent of preoperative food intake have you taken in single meal during the past month?
(Ans. Q34)
About ( ) % of the preoperative single ingested amount
35On average, what percent of preoperative food intake have you taken per day during the past month?
(Ans. Q35)
About ( ) % of the preoperative total daily ingested amount
36On average, how many main meals have you taken per day during the past month?
(Ans. Q36)
About ( ) times per day
37On average, how often have you taken additional meals (light meal or snack) per day during the past month?
(Ans. Q37)
About ( ) times per day
38Have you had appetite during the past month?
39Have you felt hunger during the past month?
40Have you felt satiety during the past month? (Satiety refers to comfortable feeling with your stomach being full.)
(Ans. Q38-40)
1. Never 2. Occasionally (less than once a week) 3. Often (twice to three times per week)
4. Frequently (four to six times per week) 5. Always (every day)
41Please encircle the number that most accurately describes the necessity for additional meals (light meal or snack) during the past month?
(Ans. Q41)
1. Food intake was enough with main meals; three times per day.
2. Food intake was slightly insufficient with main meals; three times per day, and you sometimes needed to take additional meals.
3. Food intake was significantly insufficient with main meals; three times per day, and you had to take additional meals.
4. Even though you had taken additional meals besides main meals; three times per day, food intake was insufficient.
5. Food intake was insufficient because you were not able to take additional meals besides breakfast, lunch and dinner.
42Please encircle the number which exactly describes your living status (ability for working or housekeeping) during the past month?
(Ans. Q42)
1. You were able to handle your work or housework sufficiently and could even manage to work overtime. You enjoyed trip, sports, leisure activities, and dining out as you used to before operation.
2. You were able to work or handle housework as usual (By work as usual we mean during normal working hours without overtime). (You felt no difficulty when avoiding excessive work)
3. You had some difficulties with working or keeping house. You were able to handle lighter duties (70 to 80 percent of the previous activities).
4. You had moderate difficulties with working or keeping house (about 50 percent of the previous activities).
5. You could scarcely work or keep house.
43How often have you felt dissatisfied with the chest or abdominal symptoms due to gastrectomy during the past month?
44How often have you felt dissatisfied with being unable to eat as intended due to gastrectomy during the past month? ("being unable to eat as intended" here means that you are not able to eat what you like, with no limitation in amount and in speed.)
45How often have you felt dissatisfied with your limited daily activities (working or housekeeping) due to gastrectomy during the past month?
(Ans. Q43-45)
1. Not at all 2. Slightly 3. Moderately 4. Significantly 5. Extremely
PGSAS-45 original items [item 24-45] English version 1.0 © 2016 K Nakada, M Takahashi
Table 3 Comparison of patients' characteristics, living status and quality of life between total and distal gastrectomy
TG (n = 393)
DG (n = 1384)
P valueCohen's d
meanSDmeanSD
Patients'Age (yr)63.49.261.89.10.00192(0.18)
characteristicsSex (male: n/%)276/71.0%912/66.2%0.07983-
Postoperative period (mo)35.024.637.927.40.09182(0.10)
SymptomsTotal symptom score2.20.71.90.7< 0.000120.35
Living statusChange in body weight (%)1-13.8%7.9%-8.3%7.6%< 0.000120.71
Necessity for additional meals2.40.81.90.8< 0.000120.61
Ability for working2.00.91.80.9< 0.000120.31
QOLDissatisfaction for daily life SS2.30.91.90.8< 0.000120.53
Physical component summary149.65.650.65.60.00202(0.18)
Mental component summary149.26.049.95.70.04262(0.12)
The interpretation of effect sizeCohen's d
None-very small< (0.2)
Small≥ 0.2
Medium≥ 0.5
Large≥ 0.8
Table 4 Clinical factors affecting quality of life in the patients after gastrectomy (Multiple Regression Analysis)
Dissatisfaction for daily life SS
Physical component summary1
Mental component summary1
βP valueβP valueβP value
Type of gastrectomy [TG](0.047)0.0132(0.008)NS(-0.056)0.0238
Age(-0.091)< 0.0001(-0.052)0.0236(0.090)0.0002
Sex [Male](-0.016)NS(0.043)0.0576(0.025)NS
Period after gastrectomy(-0.026)NS(-0.019)NS(-0.004)NS
Total symptoms score0.429< 0.0001-0.354< 0.0001-0.357< 0.0001
Change in body weight1(-0.036)0.0551(0.026)NS(-0.008)NS
Necessity for additional meals0.176< 0.0001(0.057)0.0206(-0.020)NS
Ability for working0.360< 0.0001-0.377< 0.0001-0.321< 0.0001
R2 (P value)0.606< 0.00010.368< 0.00010.333< 0.0001
If βis positive, the score of the outcome measure of the patients belonging to the category in [brackets] is higher in cases when the factor is
a nominal scale, and the score of outcome measure of the patients with larger values is higher in cases when the factor is a numeral scale.
The interpretation of effect sizeβR2
None-very small< (0.100)< (0.020)
Small≥ 0.100≥ 0.020
Medium≥ 0.300≥ 0.130
Large≥ 0.500≥ 0.260
Table 5 Clinical factors affecting quality of life in the patients after each of total or distal gastrectomy (Subgroup Multiple Regression Analysis)
Dissatisfaction for daily life SS
Physical component summary1
Mental component summary1
βP valueβP valueβP value
TG
Age-0.1350.0007-0.1600.00060.1180.0141
Sex (male)(0.003)NS(0.065)NS(-0.074)NS
Period after gastrectomy(-0.036)NS(0.029)NS(-0.054)NS
Total symptoms score0.428< 0.0001-0.441< 0.0001-0.350< 0.0001
Change in body weight1(-0.001)NS(0.020)NS(-0.034)NS
Necessity for additional meals0.281< 0.0001(0.085)0.0653(-0.028)NS
Ability for working0.335< 0.0001-0.334< 0.0001-0.415< 0.0001
R2 (P value)0.565< 0.00010.434< 0.00010.393< 0.0001
DG
Age(-0.081)0.0001(-0.018)NS(0.081)0.0029
Sex (male)(0.025)NS(0.036)NS(0.052)0.0502
Period after gastrectomy(-0.027)NS(-0.033)NS(0.011)NS
Total symptoms score0.441< 0.0001-0.316< 0.0001-0.355< 0.0001
Change in body weight1(-0.044)0.0265(0.024)NS(0.006)NS
Necessity for additional meals0.139< 0.0001(0.043)NS(-0.019)NS
Ability for working0.377< 0.0001-0.390< 0.0001-0.289< 0.0001
R2 (P value)0.598< 0.00010.347< 0.00010.322< 0.0001
If βis positive, the score of the outcome measure of the patients belonging to the category in [brackets] is higher in cases when the factor is
a nominal scale, and the score of outcome measure of the patients with larger values is higher in cases when the factor is a numeral scale.
The interpretation of effect sizeβR2
None-very small< (0.100)< (0.020)
Small≥ 0.100≥ 0.020
Medium≥ 0.300≥ 0.130
Large≥ 0.500≥ 0.260
Table 6 Influence of various symptoms on patients' living status and quality of life (Multiple regression analysis)
Change in body weight1
Necessity for additional meals
Ability for working
Dissatisfaction for daily life SS
Physical component summary1
Mental component summary1
βP valueβP valueβP valueβP valueβP valueβP value
Esophageal reflux SS(-0.04)NS(0.052)NS(0.081)0.0126(0.085)0.0011-0.126< 0.0001(-0.085)0.0062
Abdominal pain SS(0.042)NS(-0.004)NS(0.096)0.00460.146< 0.0001-0.261< 0.0001(-0.094)0.0039
Meal-related distress SS-0.170< 0.00010.279< 0.00010.1160.00120.282< 0.0001(-0.074)0.0263-0.144< 0.0001
Indigestion SS(-0.036)NS(0.004)NS(-0.001)NS(0.015)NS(0.024)NS(-0.058)0.0699
Diarrhea SS(0.023)NS(-0.037)NS(-0.076)0.0061(0.011)NS(0.022)NS(-0.054)0.0441
Constipation SS(0.062)0.0431(0.007)NS(0.093)0.0008(0.006)NS(-0.037)NS(-0.056)0.0356
Dumping SS(-0.051)NS0.1130.00150.214< 0.00010.283< 0.0001-0.168< 0.0001-0.141< 0.0001
R2 (P value)0.040< 0.00010.148< 0.00010.202< 0.00010.483< 0.00010.276< 0.00010.240< 0.0001
If βis positive, the score of outcome measure of the patients with larger values is higher
The interpretation of effect sizeβR2
None-very small< (0.100)< (0.020)
Small≥ 0.100≥ 0.020
Medium≥ 0.300≥ 0.130
Large≥ 0.500≥ 0.260