J Gastric Cancer.  2014 Mar;14(1):15-22.

The Impact of Esophageal Reflux-Induced Symptoms on Quality of Life after Gastrectomy in Patients with Gastric Cancer

• Im MH
• Kim JW
• Kim WS
• Kim JH
• Youn YH
• Park H
• Choi SH

Abstract

PURPOSE
To evaluate the prevalence of esophageal reflux-induced symptoms after gastrectomy owing to gastric cancer and assess the relationship between esophageal reflux-induced symptoms and quality of life.
MATERIALS AND METHODS
From January 2012 to May 2012, 332 patients were enrolled in this cross-sectional study. The patients had a history of curative resection for gastric cancer at least 6 months previously without recurrence, other malignancy, or ongoing chemotherapy. Esophageal reflux-induced symptoms were evaluated with the GerdQ questionnaire. The quality of life was evaluated with the European Organization for Research and Treatment QLQ-C30 and STO22 questionnaires.
RESULTS
Of the 332 patients, 275 had undergone subtotal gastrectomy and 57 had undergone total gastrectomy. The number of GerdQ(+) patients was 58 (21.1%) after subtotal gastrectomy, and 7 (12.3%) after total gastrectomy (P=0.127). GerdQ(+) patients showed significantly worse scores compared to those for GerdQ(-) patients in nearly all functional and symptom QLQ-C30 scales, with the difference in the mean score of global health status/quality of life and diarrhea symptoms being higher than in the minimal important difference. Additionally, in the QLQ STO22, GerdQ(+) patients had significantly worse scores in every symptom scale. The GerdQ score was negatively correlated with the global quality of life score (r=-0.170, P=0.002).
CONCLUSIONS
Esophageal reflux-induced symptoms may develop at a similar rate or more frequently after subtotal gastrectomy compared to that after total gastrectomy, and decrease quality of life in gastric cancer patients. To improve quality of life after gastrectomy, new strategies are required to prevent or reduce esophageal reflux.

Keyword

Stomach neoplasms; Gastrectomy; Esophageal reflux; Quality of life

MeSH Terms

Cross-Sectional Studies
Diarrhea
Drug Therapy
Gastrectomy*
Gastroesophageal Reflux
Humans
Prevalence
Quality of Life*
Recurrence
Stomach Neoplasms*
Weights and Measures
Surveys and Questionnaires

Figure

• 

  Fig. 1 Functional scales and global health status/quality of life (QoL) of the European Organization for Research and Treatment QLQ-C30. P-values were calculated by t-test. GerdQ (+) = GerdQ score ≥8; GerdQ (-) = GerdQ score <8; PF = physical function; RF = role function; EF = emotional function; CF = cognitive function; SF = social function; GQ = global QoL; DoM = difference of means; MID = minimal important difference. *Mark represents the domain with a difference greater than or equal to the MID. MIDs were from the article and the MID in the domain of the emotional function could not be determined from the article [25].

• 

  Fig. 2 Symptom scales of the European Organization for Research and Treatment QLQ-C30. P-values were calculated by t-test. GerdQ (+) = GerdQ score ≥8; GerdQ (-) = GerdQ score <8; FA = fatigue; NV = nausea & vomiting; PA = pain; DN = dyspnea; IN = insomnia; AL = appetite loss; CO = constipation; DI = diarrhea; FD = financial difficulties; DoM = difference of means; MID = minimal important difference. *Mark represents the domain with a difference greater than or equal to the MID. MIDs were from the article [25].

• 

  Fig. 3 Symptom scales of the European Organization for Research and Treatment QLQ-STO22. P-values were calculated by t-test. GerdQ (+) = GerdQ score ≥8; GerdQ (-) = GerdQ score <8; DP = dysphagia; PA = pain; RE = reflux; ER = eating restriction; AN = anxiety; DM = dry mouth; TA = taste; BI = body image; HL = hair loss. *Mark represents the domains with differences greater than or equal to the minimal important difference.

• 

  Fig. 4 Correlation analysis between the GerdQ score and Global health status/quality of life (QoL) scale. The solid line is the regression analysis line among all patients (r=-0.170, P=0.002). The dotted line is the regression line of the subgroup analysis in patients with a GerdQ score >6 (r=-0.305, P<0.001).

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