Gastroparesis
Will Lavercombe
Background
- Syndrome of objectively delayed gastric emptying in absence of mechanical obstruction
- Etiology: Diabetes (most common), post-surgical (gastric or bariatric surgery), thyroid dysfunction, autoimmune or neurologic disorders, medication-induced (GLP-1 agonists, narcotics, anticholinergic agents
Presentation
- Nausea, vomiting (may contain food eaten several hours prior), abdominal pain (dull, crampy; rarely a predominant symptom), early satiety, postprandial fullness, bloating, weight loss in severe cases
Evaluation
- Exclude mechanical obstruction and mucosal disease with CTE and EGD.
- Scintigraphic gastric emptying study = gold standard for diagnosis (measures gastric retention of solids at 4h).
- 13C-spirulina breath test is recognized as a validated alternative to the emptying study.
- Stop medications that may affect gastric emptying 48 hrs prior to testing.
- Must have blood sugar < 275 (Hyperglycemia delays gastric emptying).
Management
- Support with IVF and electrolytes – PO intake preferred.
- Glycemic control in diabetics.
- Stop offending medications.
- Nutrition consult for teaching on frequent small volume meals that are low in fat and soluble fiber.
- If continued symptoms after above, try prokinetics and antiemetics.
- Prokinetics (liquid formulations preferred for better absorption). Give 15 mins before meals and at bedtime.
- First line is Reglan. If no response, try Domperidone and subsequently erythromycin (not good for long term, pts develop tachyphylaxis).
- Antiemetics: helps symptoms but does not improve gastric emptying.
- In severe cases patients may require enteral feeding (post pyloric preferred) or venting g-tube.
- Emerging endoscopic treatment options: G-POEM (gastric peroral endoscopic myotomy) and gastric electrical stimulation (gastric pacemaker).
