Home Forums Other Specialities Gastroenterology GASTROPARESIS

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    Anonymous
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    A variety of symptoms raise the possibility of gastroparesis. The ACG recently published some very practical, updated guidelines on gastroparesis. The definition of gastroparesis is a patient with evidence of delayed gastric emptying without evidence of an outlet obstruction.

    Gastroparesis is a very common condition. It is prevalent in postsurgical patients, particularly after fundoplication. Identifiable causes should be sought in every patient in whom you suspect a gastroparetic condition. The differential should include diabetes because it is prevalent in these patients. In community settings, 5% of patients with type 1 diabetes, 1% of patients with type 2 diabetes, and about 0.2% of nondiabetics have gastroparesis.

    ACG recommends taking a good history, because often a gastroparetic condition will begin after a viral illness. Patients will say, “I felt fine until I got this illness and started having nausea and vomiting.” Look for prodromal symptoms from a viral illness, and evaluate your patients for a history of diabetes, gastric surgery, fundoplication, thyroid disease, and endocrine and rheumatologic diseases.
    The recommendation is to test all patients for glycemic control with a hemoglobin A1c and thyroid disease. Directed testing should follow for autoimmune, rheumatologic, or neurologic diseases that can overlap with gastroparetic disease.

    DIAGNOSIS

    Solid-phase gastric emptying (<50%at 4 hrs is the gold standard)
    New diagnostic tests like 13C breath test,wireless motility capsule need further evaluation.
    Exclude - Eating disorders(anorexia,bulimia),Cyclic vomiting syndrome,cannabinoid usage.

    MANAGEMENT

    Correct electrolyte imbalance, nutrition evaluation (Micro and Macro), vitamin D deficiency
    Diet- Low fat,low residue,soft and cooked foods,small frequent meals.

    Medical therapy
    Metoclopramide (watch for tardive dyskinesia,tachyphylaxis)
    Domperidone (Watch for hyper prolactinemia,prolonged QT)
    Erythromycin (Increases MMcomplexes, watch for Prolonged QT,Tachyphylaxis,severe cramping)
    Botulinumtoxin type A ?

    Surgical and other team approaches.

    Ref Medscape Gastroenterology-David A Johnson MD
    Prof of Medicine,Chief of GI
    Eastern Virginia Medical School,Norfolk, Virginia

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