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October 6, 2013 at 9:48 am #2626AnonymousInactive
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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