Gastroparesis

Abstract

A 37-year-old Caucasian female is referred to gastroenterology for the evaluation of chronic nausea, vomiting, early satiety, and epigastric pain. Nausea is intermittent, located in the epigastric area, and often worse after ingestion of food. The patient describes forceful emesis after meals, and the vomitus consists of partially and/or undigested food. Her epigastric pain is sometimes worsened by eating without any particular food group implicated. Additionally, her abdominal pain is sometimes located in the right upper quadrant and exacerbated by twisting and/or bending movements. The patient's medical history is significant for cholecystectomy, gastroesophageal reflux disease, and major depressive disorder. She takes escitalopram for depression and ondansetron for relief of nausea. She denies alcohol, tobacco, and illicit substance use. Physical examination is remarkable for local RUQ tenderness at a port site (from her prior cholecystectomy); pain increases with palpation during head flexion, indicating a positive Carnett's sign. Routine hematologic and chemistry studies, TSH, and hemoglobin A1c testing are normal. An upper endoscopy is completely normal and the pylorus is patent. She undergoes further diagnostic testing with a 4 h solid phase gastric scintigraphy study which reveals 25 % meal retention at 4 h (normal 0-9 %). An electrogastrogram (EGG) with water load test reveals a normal 3 cpm electrical rhythm. Her diagnosis is idiopathic gastroparesis with a normal EGG rhythm.