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Gastroparesis

Hashim Hayat

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)
  • 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 15min 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 do 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)