Brief Overview: Gastroparesis is a condition characterized by delayed gastric emptying without a blockage.
Prevalence: According to the National Institute of Diabetes and Digestive and Kidney Diseases, gastroparesis is uncommon. Out of 100,000 people, about 10 men and about 40 women have gastroparesis.
Etiology: The most common form of gastroparesis is idiopathic (unknown cause). Other etiologies include: diabetes, medication-induced, bacterial and viral infections, postsurgical, neurological conditions, autoimmune causes, mesenteric ischemia, and scleroderma.
Risk Factors:
- Diabetes
- Food poisoning
- Recent abdominal surgery
- Medications (some examples are: narcotics, calcium channel blockers, tricyclic antidepressants, alpha-2 adrenergic agonists (like clonidine), GLP-1 agonists, etc.)
- Certain cancer treatments on your chest or stomach area (like radiation)
Commonly Associated Conditions:
- Diabetes
- Small cell lung cancer
- Scleroderma
- Mesenteric ischemia
- Hypothyroidism
- Nervous system conditions, like: migraines, Parkinson’s, MS
- GERD
- Eating disorders
- Amyloidosis
Common Medications:
- Prokinetics (increase rate of gastric emptying): metoclopramide, domperidone, macrolide antibiotics (examples: – erythromycin, azithromycin), cisapride, prucalopride
- Neurokinin 1 antagonists (typically used to treat chemotherapy-induced nausea and vomiting) – aprepitant, tradipitant
- Antiemetics – diphenhydramine, ondansetron
- Tricyclic antidepressants – like nortriptyline
Common Labs, Imaging, and Tests:
- Upper GI endoscopy
- CT enterography or MR enterography
- Barium follow-through exam
- Scintigraphic gastric imaging test (nuclear medicine imaging)
- 13C breath testing
- SmartPill test
- Lab tests: hemoglobin, fasting plasma glucose, serum total protein, albumin, TSP, ANA, HgbA1c (if diabetic)
- If long-standing history of smoking – ANNA-1 or anti-uHu antibody tests
- If a cause is unable to be determined after initial testing, additional tests may be ordered
Common Symptoms:
- Nausea and vomiting
- Abdominal pain
- Early satiety (feeling full soon after starting to eat)
- Postprandial fullness
- Bloating, belching
- Weight loss in severe cases
- Heartburn
- Poor appetite
Common Treatments:
- Dietary modification
- Achieving, and maintaining, control of diabetes
- Adequate hydration
- Vitamin supplementation
- Medications (see above)
- Gastrostomy tube to vent gastric contents
- Jejunostomy tube for enteral nutrition
Physical Findings:
- Epigastric distention, tenderness
- Succession splash
- Weight loss
Potential Complications and Contraindications:
- Acute exacerbations
- Dehydration
- Malnutrition
- Difficult to control diabetes
- Unintentional weight loss
- Electrolyte imbalances
- Medication side effects
General Health and Lifestyle Guidance:
- Follow any dietary modifications recommended by your healthcare provider
- Maintain adequate hydration
- Sit upright or walk after meals
- Chew food thoroughly and eat slowly
- Achieve, and maintain, control of diabetes
Suggested Questions to Ask Patients:
- Do you feel full quickly when eating or experience frequent bloating?
- Have you had episodes of vomiting undigested food?
- Have you lost weight unintentionally?
- Do you have diabetes or other chronic conditions?
- Are you currently taking medications that could slow digestion (some examples are listed under risk factors)?
Suggested Talking Points:
- Control of diabetes is very important for patients with gastroparesis
- Tell your healthcare provider about any new or worsening symptoms
- Talk with your healthcare provider or dietician about any recommended dietary modifications
- Talk with your healthcare provider about your recommended fluid intake and any recommended vitamin supplementation
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