Gastroenterology Book

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Gastroparesis

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  1. Definition
    1. Delayed gastric emptying
  2. Epidemiology
    1. More common in women
  3. Pathophysiology
    1. Primary factors
      1. Impaired vagal tone
    2. Secondary factors
      1. Interstitial cells of Cajal injury
      2. Smooth muscle dysfunction
      3. Impaired function of nerves containing nitric oxide
  4. Causes
    1. Diabetes Mellitus (occurs in 5-12% of Diabetes Mellitus patients)
    2. Functional Dyspepsia
    3. Post-surgical Gastroparesis
    4. See Medications that Delay Gastric Emptying
  5. Symptoms
    1. Nausea and Vomiting
    2. Early satiety and postprandial fullness
  6. Labs
    1. Standard
      1. Complete Blood Count (CBC)
      2. Thyroid Stimulating Hormone (TSH)
      3. Chemistry panel including Serum Glucose
    2. Consider when indicated
      1. Serum Lipase or amylase
      2. Urine Pregnancy Test
  7. Diagnostics: Initial
    1. Upper endoscopy or
    2. Gastrointestinal series with small-bowel-follow-through
    3. Consider abdominal ultrasound in suspected Cholelithiasis
  8. Diagnostics: Confirmatory
    1. Gastric emptying scintagraphy
      1. Scanning at 15 minute intervals for 4 hours following radiolabeled intake
      2. Positive if greater than 10% of meal retained at 4 hours
    2. Antroduodenal manometry
      1. Indicated in cases of unexplained Vomiting
  9. Grading
    1. Mild
      1. Weight and nutrition maintained with basic, non-pharmacologic measures
    2. Compensated
      1. Weight and nutrition maintained with pharmacologic management
    3. Gastric failure
      1. Weight and nutrition not maintained despite maximal medical therapy
  10. Management: Nonpharmacologic
    1. Small, frequent meals
    2. Liquid meals are preferred
    3. Decrease fat intake
    4. Decrease fiber intake
    5. Limit Alcohol intake
    6. Tobacco Cessation
    7. Control blood sugar levels in Diabetes Mellitus
    8. Avoid provocative medications
      1. See Medications that Delay Gastric Emptying
  11. Management: Pharmacologic
    1. Antiemetics
      1. Prochlorperazine (Compazine)
      2. Promethazine (Phenergan)
      3. Ondansetron (Zofran)
    2. Prokinetics
      1. Metoclopramide (Reglan) 10 mg orally four times daily
      2. Erythromycin 250 mg orally three times daily
      3. Tegaserod (Zelnorm)
        1. Restricted use in the United States
      4. Bethanechol 25 mg orally four times daily
        1. Mixed results in studies
  12. Management: Refractory Cases (no ideal options)
    1. Gastric electric stimulation
      1. Variable efficacy
      2. Complicated by gastric Erosions in up to 10% of patients
    2. Botulinum injection to Pylorus
    3. Gastrostomy tube
  13. References
    1. Camilleri (2007) N Engl J Med 356:820
    2. Parkman (2004) Gastroenterology 127:1589
    3. Shakil (2008) Am Fam Physician 77(12):1697

Gastroparesis (C0152020)

Definition (MSH)Chronic delayed gastric emptying. Gastroparesis may be caused by motor dysfunction or paralysis of STOMACH muscles or may be associated with other systemic diseases such as DIABETES MELLITUS.
ConceptsDisease or Syndrome (T047)
ICD9536.3, 536.3
MSHD018589
EnglishATONY STOMACH, Gastric atonia, Gastric atony, Gastric Stases, Gastric Stasis, Gastroparalysis, Gastropareses, Gastroparesis, Gastroparesis syndrome, PARALYSIS GASTRIC, STOMACH ATONY
Spanishatonia gastrica, estasis gastrica, estasis gastrico, gastroparesia, sindrome de gastroparesia
Parent ConceptsParasympatholytics (C0030511), Stomach Diseases (C0038354), GASTRIC/DUODENAL (C0549614), Disorder of function of stomach (C0156084), Paralysed (C0522224), Ambiguous concept (C1274012)
SourcesCOSTAR, CSP, CST, ICD9CM, MSH, MTHICD9, NDFRT, OMIM, SCTSPA, SNOMEDCT
Derived from the NIH UMLS (Unified Medical Language System)



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