Gastroparesis

Abstract

Gastroparesis (GP) is a chronic neuromuscular disorder of the upper gastrointestinal tract. The incidence of GP is not well described; however, the number of individuals affected by symptoms of GP in the United States is estimated to be over 4 million. The etiology of GP is diverse. Approximately 25% of cases are associated with diabetes, whereas nearly 50% are classified as idiopathic; many of these latter cases likely represent a postinfectious process. Connective tissue disorders, autoimmune disorders, prior gastric surgery, ischemia, and medications make up the vast majority of the remaining cases. The pathophysiology of GP is also diverse. Abnormalities in fundic tone, antroduodenal dyscoordination, a weak antral pump, gastric dysrhythmias, and abnormal duodenal feedback all contribute to delays in gastric emptying and symptom expression. Characteristic symptoms of GP include nausea, vomiting, epigastric pain, early satiety, and weight loss. The diagnosis of GP is made using a combination of characteristic symptoms in conjunction with objective evidence of delayed gastric emptying in the absence of mechanical obstruction. Once the diagnosis is made, treatment options include dietary modification, medications to accelerate gastric emptying, antiemetic agents, gastric electrical stimulation, and surgery. In the following sections we will provide an overview of the health care impact of GP, describe the underlying pathophysiology, and review treatment options using an evidence-based approach.

Disorders of the brain-gut interaction and eating disorders

“…Gastroparesis is a neuromuscular disorder of the upper gastrointestinal tract characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach[ 15 , 16 ]. The clinical outcome of the delayed gastric emptying is a combination of symptoms, including early satiety, postprandial fullness, nausea, vomiting, belching, and bloating.…”

Nutrition Therapy for Dysphagia, EoE, Gastroparesis, GERD, and Liver Disease

“…The diagnosis of gastroparesis (GP) is based on the combination of a delay in gastric emptying and upper GI symptoms in the absence of a gastric outlet obstruction (Camilleri et al 2013). While multiple conditions have been associated with GP, most cases are idiopathic, diabetic, postsurgical, and medication-induced (Stein et al 2015). Common symptoms include early satiety, postprandial fullness, nausea, vomiting, bloating, abdominal distension, and upper abdominal pain.…”

Gastric outlet obstruction: A red flag, potentially manageable

“…Other causes include viral infection, connective tissue diseases, ischemia, infi ltrative disorders, radiation, neurologic disorders, and paraneoplastic syndromes. 39,40 Gastric outlet obstruction and gastroparesis share clinical symptoms including nausea, vomiting, abdominal pain, early satiety, and weight loss and are important to differentiate. 36,38 Although abdominal pain may be present in both gastric outlet obstruction and gastroparesis, in gastroparesis it tends not to be the dominant symptom.…”

“…40 Gastric scintigraphy is most commonly used to objectively quantify delayed gastric emptying. 39 Upper endoscopy is imperative to exclude mechanical obstruction. 39…”