Nakmura et al developed the Dysfunction after Upper Gastrointestinal Surgery (DAUGS) scoring system. This correlated with the quality of life following the surgery. The authors are from Jichi Medical University, Osaka University, and the Osaka Medical Center for Cancer and Cardiovascular Diseases in Japan.

Patient selection: following upper GI surgery (esophagectomy, gastrectomy, other)


Instrument: 20 questions (reduced from a previously reported 32 items)


Scoring: from 0 to 5



(1) feeling more full halfway through a meal (as compared to before the surgery)

(2) heavy sensation in the stomach after eating

(3) suddenly feeling bloated during a meal

(4) abdominal fullness after eating

(5) loss of appetite

(6) difficulty swallowing soft food

(7) choking sensation when swallowing

(8) difficulty sleeping because of gastroesophageal reflux

(9) acid in mouth from gastroesophageal reflux

(10) vomiting after meal

(11) feeling of food stuck in chest

(12) nausea

(13) pain in pit of stomach after eating

(14) abdominal pain within 30 minutes of eating

(15) fatigue or weakness within 2-3 hours after eating

(16) feel sleepy within 2-3 hours after eating

(17) soft stools

(18) diarrhea

(19) lower strength or activity level

(20) dizzy or unsteady when walking uphill or up a stairs




never or none


rare or very slight


occasional or mild


often or moderate


very often or severe


constant or very severe




• Mixing frequency and severity in the response may be a limitation. Other instruments record both and may multiply the two.


total score =

= SUM(points for all 20 items)



• minimum score: 0

• maximum score: 100

• The higher the score the more severe the symptoms.

• The quality of life tended to move in the opposite direction, with a high score associated with a poor quality of life.

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