Gastroparesis: Clinical Update. CME

Park, Moo In; Camilleri, Michael

doi:10.1111/j.1572-0241.2006.00640.x

Cited by 116 publications

(84 citation statements)

References 102 publications

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“…5,6 Its pathogenesis has not been fully elucidated to date, 5,7 and the most common cause has been known to be idiopathic, including post-viral infection; diabetes and postsurgical complications are its other causes. 5,7 Its mechanisms include impaired gastric accommodation, antral hypomotility with pyloric spasm, duodenal dysmotility, among others.…”

Section: Diagnosis: Idiopathic Gastroparesismentioning

confidence: 99%

Idiopathic Gastroparesis Treated with Gastric Peroral Endoscopic Pyloromyotomy Using Endolumenal Functional Lumen Imaging Probe

Kang

Jung

2017

Korean J Gastroenterol

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Case: A 25-year-old man presented to the emergency clinic with epigastric pain. He was previously very healthy and served as a soldier. He developed abrupt epigastric pain and diarrhea three months prior to his initial visit. A doctor at the local clinic suspected infectious colitis and was prescribed an antibiotic at his first visit; however, there was no symptomatic improvements. He underwent colonoscopy, and intravenous hydrocortisone was prescribed under the impression of ulcerative colitis at the local clinic. This provided mild, transient symptomatic improvement and the patient was able to eat food. However, intermittent abdominal pain and nausea continued, and the patient lost 10 kg of weight during the first month. Later, the patient experienced abdominal pain, fever, and myalgia, and he was then referred to Asan Medical Center. His abdominal computed tomography (CT) scan showed a mild thickening of the gall bladder, but without stone. Under the impression of chronic cholecystitis, he underwent laparoscopic cholecystectomy. However, despite surgery, he still complained of chronic epigastric pain, nausea, and vomiting. He underwent upper endoscopy, which showed normal findings. Despite medical therapy with several prokinetics, including metoclopramide, he still experienced epigastric pain, nausea, and vomiting, resulting in more than 20 kg of weight loss during the last three months.Due to nausea and vomiting, he was unable to keep down any solid food, and required total parenteral nutrition. He was referred to the gastrointestinal (GI) clinic due to continuous abdominal pain, nausea, and vomiting without abnormal laboratory test results, including autoimmune antibodies and other inflammatory makers. To rule out gastric dysmotility disorder, gastric emptying scan (GES) was recommended.However, he was unable to eat the test meal for GES due to severe nausea. Instead of GES, he underwent barium upper GI series, which showed definite delayed barium passage at the pyloric ring (Fig. 1A, B). Electrogastrography revealed a representative image of gastric outlet obstruction (Fig. 2).

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Section: Diagnosis: Idiopathic Gastroparesismentioning

confidence: 99%

Idiopathic Gastroparesis Treated with Gastric Peroral Endoscopic Pyloromyotomy Using Endolumenal Functional Lumen Imaging Probe

Kang

Jung

2017

Korean J Gastroenterol

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“…5) and more rapidly than solids, with no lag phase. A previously held belief was that liquid GE added little to the evaluation of patients with dyspepsia (33,34). It was felt that since the liquids require no trituration, liquid GE remained normal until gastroparesis was at an advanced stage and that liquids were therefore less sensitive than solids for detecting early gastroparesis (35).…”

Section: Gastric Emptyingmentioning

confidence: 99%

Gastrointestinal Motility, Part 1: Esophageal Transit and Gastric Emptying

Maurer

2016

J. Nucl. Med. Technol.

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CE credit: For CE credit, you can access the test for this article, as well as additional JNMT CE tests, online at https://www.snmmilearningcenter.org. Complete the test online no later than March 2019. Your online test will be scored immediately. You may make 3 attempts to pass the test and must answer 80% of the questions correctly to receive 1.0 CEH (Continuing Education Hour) credit. SNMMI members will have their CEH credit added to their VOICE transcript automatically; nonmembers will be able to print out a CE certificate upon successfully completing the test. The online test is free to SNMMI members; nonmembers must pay $15.00 by credit card when logging onto the website to take the test.Although not as well standardized as gastric emptying (GE) scintigraphy, esophageal transit scintigraphy, if performed in a comprehensive manner including both quantitative and qualitative analysis of single-and multiple-swallow studies, is clinically useful when expertise in esophageal manometry is not available or not tolerated and when esophageal manometry or barium videofluoroscopy results are equivocal or nondiagnostic. GE scintigraphy has undergone much-needed standardization. Both solid and liquid GE studies play an important role in assessing patients with upper gastrointestinal symptoms. Because measurement of simple total GE is often not sufficient to explain patient symptoms, there is a need to expand the analysis of GE scintigraphy to include the separate roles of the fundus and antrum and to include the complex interactions the stomach has with other organ systems.

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“…Studies have shown these agents to increase gastric emptying by 25 to 75% and reduce the severity of symptoms by 25 to 68%. 10,11,12 When pain relief is required, tramadol and opiates should be avoided. These have inhibiting effects on motility.…”

Section: Managementmentioning

confidence: 99%

Case Report-The 46 year old man with a 5 month history of vomiting

Segula¹,

Mwandiambira²,

Howson³

et al. 2011

Mal. Med. J

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MalawiOn the 23rd of January 2011, we admitted a 46-year-old man to Queen Elizabeth Central Hospital (QECH) with a 5-month history of recurrent vomiting. This was associated with nausea. He would vomit at least 5 times per day. The vomitus was non-projectile, would usually take the colour of the food eaten and was never bilious. There was no history of abdominal pain, dysphagia, fever or headache. The colour of stools was normal but he had complained of constipation for 6 days prior to admission. He also admitted to weight loss, which could not be quantified. Prior to attending QECH he had been seen in several health facilities and had been treated with promethazine, but had had no relief of his symptoms. An endoscopy done at another hospital was documented as follows: 'endoscopy shows reflux oesophagitis and lax lower oesophageal sphincter' There was no comment on whether there were structural abnormalities at the level of the pylorus or duodenum. He had been diagnosed with type 2 diabetes mellitus in December 2010 on the basis of high random blood glucose readings. He had been prescribed glibenclamide but stopped as he felt it was making him vomit more, and was now only taking metformin. Blood glucose measurements since the start of treatment were not available so we do not know how well the diabetes had been controlled. He had a history of moderate alcohol consumption (< 20 units per week) but had not taken alcohol since the symptoms started. He had no history of smoking. He was HIV negative. He used to work as a foreman for a construction company but had stopped work owing to the severity of his symptoms. He was married with 3 children. There was no family history of diabetes. On examination, he was moderately cachexic and dehydrated. His blood pressure (BP) was 130/80 mmHg, temperature 37oC, pulse 92/minute, respiratory rate 28/minute. His conjunctivae were pink, there were no oral lesions and he had no lymphadenopathy, including Virchow's node. Chest examination was normal. Abdominal examination was normal except there were hard stools in the rectum. His fundoscopy showed dot and blot haemorrhages, consistent with background diabetic retinopathy. His random blood glucose concentration was 252mg/dl and there were no ketones in his urine. Blood potassium and sodium were 3.1 mmol/L (3.6 -5.0) and 127 mmol/L (135 -145) respectively. He had a normal blood creatinine and no proteinuria. Discussion 1) Causes of vomiting can be divided into gastrointestinal causes, central causes and metabolic causes. In this case the causes of vomiting that should be considered include gastrointestinal causes such as achalasia, gastric malignancy, pyloric stenosis, gastric or duodenal ulcer, gastroparesis and generalized motility disorders such as intestinal myopathies and neuropathies. Central causes include migraine, cyclical vomiting, psychogenic vomiting, space occupying lesions and labyrinthitis. Metabolic causes such as drugs, hypercalcaemia and hyponatraemia should also be considered. 2)A careful history and examination ar...

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Gastroparesis: Clinical Update. CME

Cited by 116 publications

References 102 publications

Idiopathic Gastroparesis Treated with Gastric Peroral Endoscopic Pyloromyotomy Using Endolumenal Functional Lumen Imaging Probe

Idiopathic Gastroparesis Treated with Gastric Peroral Endoscopic Pyloromyotomy Using Endolumenal Functional Lumen Imaging Probe

Gastrointestinal Motility, Part 1: Esophageal Transit and Gastric Emptying

Case Report-The 46 year old man with a 5 month history of vomiting

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