Gastroenterology Book

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Gastroparesis

Aka: Gastroparesis
  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 356:820-9
    2. Parkman (2004) Gastroenterology 127:1589-91
    3. Shakil (2008) Am Fam Physician 77(12): 1697-702

Gastroparesis (C0152020)

Definition (NCI) Paralysis of the muscles of the stomach wall resulting in delayed emptying of the gastric contents into the small intestine.
Definition (NCI) A disorder characterized by an incomplete paralysis of the muscles of the stomach wall resulting in delayed emptying of the gastric contents into the small intestine.
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)
MSH D018589
ICD9 536.3
SnomedCT 77164002, 235675006, 196753007
English STOMACH ATONY, GASTROPARESIS, ATONY STOMACH, GASTRIC ATONY, Gastric Stases, Gastric Stasis, Gastropareses, Stases, Gastric, Stasis, Gastric, Gastroparesis syndrome, NOS, PARALYSIS GASTRIC, gastroparesis (diagnosis), gastroparesis, Gastroparesis syndrome (disorder), Atony of stomach, Atony stomach, Stomach atony, Paralysis gastric, Gastroparesis [Disease/Finding], delayed gastric emptying, gastric paralysis, gastric atony, gastropareses, Gastroparesis, Gastric atony, Gastric stasis, Gastric atonia, Gastric atonia (disorder), Gastroparesis (disorder), Gastroparesis syndrome, atony; stomach, paralysis; stomach, stomach; paralysis, Gastroparesis syndrome (disorder) [Ambiguous], Gastroparalysis, Stasis;gastric, gastric stasis
German GASTROPARESE, Atonie des Magens, Laehmung, Magen, Magenstase, MAGENATONIE, Magenatonie, Gastroparese, Gastraler Rückstau
Portuguese GASTROPARESIA, Paralisia gástrica, Atonia do estômago, Estase gástrica, ATONIA GASTRICA, Atonia gástrica, Estase Gástrica, Gastroparesia
Italian Atonia gastrica, Paralisi gastrica, Atonia dello stomaco, Stasi gastrica, Gastroparesi
Dutch gastroparese, maagstase, atonie van de maag, atonie maag, maagparalyse, atonie; maag, maag; paralyse, paralyse; maag, maagatonie, Gastroparalyse, Gastroparese, Maagverlamming
French Atonie de l'estomac, Paralysie gastrique, Atonie stomacale, ATONIE GASTRIQUE, GASTROPARESIE, Atonie gastrique, Gastroparésie, Stase gastrique
Spanish Atonía de estómago, Estasis gástrica, Parálisis gástrica, GASTRICA, ATONIA, GASTROPARESIA, Gastroparesia, Gastroparesis, atonía gástrica (trastorno), atonía gástrica, estasis gástrica, gastroparesia (trastorno), gastroparesia, síndrome de gastroparesia (concepto no activo), síndrome de gastroparesia (trastorno), síndrome de gastroparesia, Atonía gástrica, estasis gástrico, Estasis Gástrica, Estasis Gastrica
Japanese 胃アトニー, 胃内容うっ滞, 胃麻痺, ｲﾏﾋ, ｲﾅｲﾖｳｳｯﾀｲ, ｲｱﾄﾆｰ, ｲﾌｾﾞﾝﾏﾋ, 胃のうっ滞, 軽症胃アトニー, 胃不全麻痺
Swedish Magmuskelförlamning
Czech žaludek - paréza, gastroparéza, Gastroparéza, Paralýza žaludku, Atonie žaludku, Žaludeční stáza, Žaludeční atonie
Finnish Gastropareesi
Russian GASTROPAREZ, ZHELUDOCHNYI STAZ, ГАСТРОПАРЕЗ, ЖЕЛУДОЧНЫЙ СТАЗ
Polish Gastroplegia, Niedowład żołądka, Zastój żołądkowy, Porażenie żołądka
Hungarian Gyomoratonia, Gyomor paralysis, Gyomor atónia, Gastroparesis, Gyomor atonia, Gyomor atoniája, Gyomor stasis
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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