Review Article

Gastroparesis

Authors: Tauseef Ali, MD, Muhammad Hasan, MD, Mehdi Hamadani, MD, Richard F. Harty, MD

Abstract

Gastroparesis is a symptomatic disorder of the stomach characterized by slow or delayed gastric emptying. Diabetes and idiopathic factors account for over 60% of gastroparesis cases. Symptoms associated with delayed gastric emptying include nausea, vomiting, abdominal bloating and early satiety. Delayed gastric emptying due to gastroparesis is managed by dietary adjustments, prokinetic medications, avoidance of medications that retard gastric motor activity and optimizing glycemic control in diabetic patients. Electrical stimulation and gastric pacing are an evolving treatment option for patients who do not respond to standard medical therapy. This article provides a review of gastric motility, the etiologies of gastroparesis and therapeutic approaches to this disorder.


Key Points


* Gastroparesis is defined as delayed gastric emptying. Initial investigations for gastroparesis include comprehensive history and physical examination that can lead to important clues.


* The general principles for treatment of symptomatic gastroparesis are to correct fluid, electrolyte, and nutritional deficiencies, identify and rectify the underlying cause of gastroparesis, and reduce symptoms.


* Prokinetic agents increase antral contractility, correct gastric dysrhythmias, improve antroduodenal coordination and are used to treat the symptoms of gastroparesis.


* Gastric electric stimulation accelerates gastric emptying and improves dyspeptic symptoms.

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References

1. Parkman HP, Hasler WL, Fisher RS, et al. American Gastroenterological Association Technical Review on the Diagnosis and Treatment of Gastroparesis. Gastroenterology 2004;127:1592–1622.
 
2. Soykan I, Sivri B, Sarosiek I, et al. Demography, clinical characteristics, psychological profiles, treatment and long-term follow-up of patients with gastroparesis. Dig Dis Sci 1998;43:2398–2404.
 
3. Datz FL, Christian PE, Moore J. Gender-related differences in gastric emptying. J Nucl Med1987;28:1204–1207.
 
4. Stanghellini V, Tosetti C, Paternico A, et al. Risk indicators of delayed gastric emptying of solids in patients with functional dyspepsia. Gastroenterology 1996;110:1036–1042.
 
5. Zarate N, Mearin F, Wang XY, et al. Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration: pathological findings and management. Gut 2003;52:966–970.
 
6. Sodhi SS, Guo J-P, Maurer AH, et al. Delayed gastric emptying after combined heart and lung transplantation. J Clin Gastroenterol 2002;34:34–39.
 
7. Jebbink RJ, Samsom M, Bruijs PP, et al. Hyperglycemia induces abnormalities of gastric myoelectrical activity in patients with type1 diabetes mellitus. Gastroenterology 1994;107:1390–1397.
 
8. Parkman HP, Harris AD, Krevsky B, et al. Gastroduodenal motility and dysmotility: update on techniques available for evaluation. Am J Gastroenterol 1995;90:869–892.
 
9. Ghoos YF, Maes BD, Geypens BJ, et al. Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology 1993;104:1640–1647.
 
10. Chen JD, McCallum RW. Clinical applications of electrogastrography. Am J Gastroenterol1993;88:1324–1336.
 
11. Chen JD, Lin Z, Pan J, et al. Abnormal gastric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis. Dig Dis Sci 1996;41:1538–1545.
 
12. Bujanda L. The effects of alcohol consumption upon the gastrointestinal tract. Am J Gastroenterol 2000;95:3374–3382.
 
13. Ganzini L, Casey DE, Hoffman WF, et al. The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders. Arch Intern Med 1993;153:1469–1475.
 
14. Degen L, Matzinger D, Merz M, et al. Tegaserod, a 5-HT4 receptor partial agonist, accelerates gastric emptying and gastrointestinal transit in healthy male subjects. Aliment Pharmacol Ther 2001;15:1745–1751.
 
15. McCallum RW, Chen JD, Lin Z, et al. Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology 1998;114:456–461.
 
16. Fontana RJ, Barnett JL. Jejunostomy tube placement in refractory diabeticgastroparesis: a retrospective review. Am J Gastroenterol 1996;91:2174–2178.