Overview
Gastroparesis describes delayed gastric emptying secondary to reduced peristalsis of the stomach without any mechanical obstruction.
Causes
- Idiopathic – most common
- Diabetes mellitus – due to diabetic neuropathy
- Post-gastric surgery
- Following bacterial or viral gastroenteritis
- Multiple sclerosis
- Parkinson’s disease
- Post-stroke
- Hypothyroidism
- Connective tissue disorders (e.g. systemic sclerosis, systemic lupus erythematosus etc.)
- Medications (e.g. opioids, tricyclic antidepressants, and anticholinergics)
Presentation
Features suggesting gastroparesis are:
- Early satiety
- Nausea
- Vomiting
- Bloating
- Upper abdominal pain
- Erratic blood glucose levels – seen in people with diabetes mellitus
Investigations
- Serum glucose and/or HbA1c:
- Diabetes mellitus can cause gastroparesis
- Urea and electrolytes:
- Electrolyte derangements may cause gastroparesis
- Serum amylase and/or lipase:
- To rule out pancreatitis if abdominal pain is significant
- Total protein and albumin:
- May be decreased in patients with malnutrition
- Abdominal x-ray:
- To rule out causes such as bowel obstruction
- Endoscopy:
- May be considered to rule out mechanical causes such as malignancy or pyloric stenosis
- Gastric emptying scintigraphy:
- A radioactive isotope is given with food and its progression through the GI tract is monitored
Management
Management may involve:
- Correcting fluid, electrolyte, and nutritional deficiencies
- Symptom control – prokinetic agents such as metoclopramide or domperidone
- Anti-emetics may be considered such as promethazine and prochlorperazine
- Other options include dietary changes, endoscopic botulinum toxin injection, or surgery
