Gastroparesis
  • Delayed emptying of solids by the stomach in the absence of any mechanical obstruction
  • Usually idiopathic; however, other common aetiologies include diabetes mellitus and previous gastric surgery
  • Diagnosis is made by demonstrating delayed gastric emptying in a symptomatic patient after excluding other potential causes

Presentation

  • Postprandial nausea
  • Vomiting
  • Early satiety
  • Epigastric pain
  • Fullness and bloating
  • Weight loss

History

  • Diabetes Mellitus
  • Previous gastric or pancreatic surgery
  • Females

Differentials

  • Acute pancreatitis - differentiated by raised serum amylase and/or lipase
  • Inflammatory bowel disease
  • Irritable bowel syndrome - unremarkable findings on endoscopy and abdominal x-ray
  • Functional dyspepsia

Examination

There are no characteristic findings of gastroparesis on physical examination

Laboratory investigations

  • FBC
  • Serum lipase and amylase to exclude acute pancreatitis
  • Serum glucose - if elevated, screen for diabetes mellitus
  • Potassium - <3.5 mmol/L (<3.5 mEq/L) indicating prolonged vomiting
  • Creatinine - elevated indicating abnormal renal function, due to dehydration from prolonged vomiting or the cause of gastroparesis
  • Albumin - <35 g/L (<3.5 g/dL) signifying malnutrition
  • Total protein - <60 g/L (<6 g/dL) signifying malnutrition

Radiological investigations

Abdominal X-ray to exclude other pathology

Endoscopy - exclude causes of mechanical gastric outlet obstruction including:

  • Pyloric stenosis
  • Neoplasia
  • Ulcer disease in the duodenum, pyloric channel, or prepyloric antrum

Gastric emptying scintigraphy

  • Gastric retention >10% at the end of 4 hours or >60% after 2 hours after consumption of the meal is considered to be delayed gastric emptying

Management

First line

  • Correct biochemical abnormalities with IV fluids
  • Prokinetic agent to control symptoms
    • Dopamine receptor antagonists e.g Domperidone
    • Motilin receptor agonists e.g IV Erythromycin
  • Anti-emetics
    • Histamine H1-receptor antagonists e.g promethazine and prochlorperazine commonly used
  • Opioid analgesics
  • Dietary intervention
    • Small, frequent meals
    • Low fat diet

Complications

  • Frequent hospitalisation
  • Poor glycaemic control
  • Malnutrition

Oesophagitis

Prognosis

  • Symptoms can be well controlled in most patients with a combination of prokinetics, anti-emetics, nutritional support, and strict glycaemic control in patients with diabetes.
  • Some patients do not respond to this treatment approach and continue to have repeated admissions to hospital for refractory nausea and vomiting, dehydration, and malnutrition
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