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Gastroparesis
- Definition
- Delayed gastric emptying
- Epidemiology
- More common in women
- Pathophysiology
- Primary factors
- Impaired vagal tone
- Secondary factors
- Interstitial cells of Cajal injury
- Smooth muscle dysfunction
- Impaired function of nerves containing nitric oxide
- Primary factors
- Causes
- Diabetes Mellitus (occurs in 5-12% of Diabetes Mellitus patients)
- Functional Dyspepsia
- Post-surgical Gastroparesis
- See Medications that Delay Gastric Emptying
- Symptoms
- Labs
- Standard
- Complete Blood Count (CBC)
- Thyroid Stimulating Hormone (TSH)
- Chemistry panel including Serum Glucose
- Consider when indicated
- Serum Lipase or amylase
- Urine Pregnancy Test
- Standard
- Diagnostics: Initial
- Upper endoscopy or
- Gastrointestinal series with small-bowel-follow-through
- Consider abdominal ultrasound in suspected Cholelithiasis
- Diagnostics: Confirmatory
- Gastric emptying scintagraphy
- Scanning at 15 minute intervals for 4 hours following radiolabeled intake
- Positive if greater than 10% of meal retained at 4 hours
- Antroduodenal manometry
- Indicated in cases of unexplained Vomiting
- Gastric emptying scintagraphy
- Grading
- Mild
- Weight and nutrition maintained with basic, non-pharmacologic measures
- Compensated
- Weight and nutrition maintained with pharmacologic management
- Gastric failure
- Weight and nutrition not maintained despite maximal medical therapy
- Mild
- Management: Nonpharmacologic
- Small, frequent meals
- Liquid meals are preferred
- Decrease fat intake
- Decrease fiber intake
- Limit Alcohol intake
- Tobacco Cessation
- Control blood sugar levels in Diabetes Mellitus
- Avoid provocative medications
- Management: Pharmacologic
- Antiemetics
- Prokinetics
- Metoclopramide (Reglan) 10 mg orally four times daily
- Erythromycin 250 mg orally three times daily
- Tegaserod (Zelnorm)
- Restricted use in the United States
- Bethanechol 25 mg orally four times daily
- Mixed results in studies
- Management: Refractory Cases (no ideal options)
- Gastric electric stimulation
- Variable efficacy
- Complicated by gastric Erosions in up to 10% of patients
- Botulinum injection to Pylorus
- Gastrostomy tube
- Gastric electric stimulation
- References
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. |
| Concepts | Disease or Syndrome (T047) |
| ICD9 | 536.3, 536.3 |
| MSH | D018589 |
| English | ATONY STOMACH, Gastric atonia, Gastric atony, Gastric Stases, Gastric Stasis, Gastroparalysis, Gastropareses, Gastroparesis, Gastroparesis syndrome, PARALYSIS GASTRIC, STOMACH ATONY |
| Spanish | atonia gastrica, estasis gastrica, estasis gastrico, gastroparesia, sindrome de gastroparesia |
| Parent Concepts | Parasympatholytics (C0030511), Stomach Diseases (C0038354), GASTRIC/DUODENAL (C0549614), Disorder of function of stomach (C0156084), Paralysed (C0522224), Ambiguous concept (C1274012) |
| Sources | COSTAR, CSP, CST, ICD9CM, MSH, MTHICD9, NDFRT, OMIM, SCTSPA, SNOMEDCT Derived from the NIH UMLS (Unified Medical Language System) |
