Gastroparesis: Difference between revisions
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*Malignancy | *Malignancy | ||
*[[Mesenteric ischemia]] | *[[Mesenteric ischemia]] | ||
*Esophageal disorders (e.g. achalasia, GERD, [[esophagitis]] | *Esophageal disorders (e.g. achalasia, GERD, [[esophagitis]]) | ||
*Functional disorders | *Functional disorders | ||
**Psychogenic | **Psychogenic | ||
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====Miscellaneous==== | ====Miscellaneous==== | ||
*Anorexia/bulimia | *Anorexia/bulimia | ||
==Evaluation== | ==Evaluation== | ||
Revision as of 02:21, 6 January 2017
Background
- Symptomatic chronic stomach disorder characterized by delayed gastric emptying without mechanical obstruction
- More common in women, presumed due to elevated progesterone
- Disease associated with reduced quality of life
- Most commonly seen in diabetics, but other etiologies listed below
Causes of Non-Obstructive Delayed Gastric Emptying
- Idiopathic
- Diabetes mellitus
- Postsurgical/Vagal nerve injury
- GI disorders associated with delated gastric emptying
- GERD
- Achalasia
- Atrophic gastritis
- Functional dyspepsia
- Hypertrophic Pyloric stenosis
- Celiac disease
- Non-GI disorders associated with delayed gastric emptying
- Eating disorders: Anorexia nervosa
- Neurologic disorders such as parkinson's
- Collagen vascular disorders
- Endocrine and metabolic disorders
- Thyroid/Parathyroid dysfunction
- Chronic renal insufficiency
- Medication associated
- Most commonly used: Opioid analgesics, anticholinergics, progesterone, PPIs, alcohol, tobacco
Clinical Features
- Symptons variable and include:
- Early satiety
- Nausea and vomiting
- Bloating and upper abdominal discomfort
- Abdominal pain (not predominant symptom)
- Signs, long standing disease:
- Dehydration
- Malnourishment
- Functional dyspepsia- abdominal pain is the predominant symptom
Differential Diagnosis
By organ system
GI
- Peptic ulcer disease
- Mechanical Obstruction
- Adhesion
- Small bowel obstruction/LBO
- Gastric outlet obstruction/Pyloric stenosis
- Volvulus
- Strangulated hernia
- Pancreatitis
- Appendicitis
- Cholecystitis
- Cholangitis
- Acute Hepatitis
- IBD
- Intussusception
- Malignancy
- Mesenteric ischemia
- Esophageal disorders (e.g. achalasia, GERD, esophagitis)
- Functional disorders
- Psychogenic
- IBS
Neurologic
Infectious
Drugs/Toxins
- Heavy metal poisoning
- Methanol poisoning
Endocrine
Miscellaneous
- Anorexia/bulimia
Evaluation
- Diagnosed by demonstrating delayed gastric emptying in a symptomatic patient after other etiologies are excluded
- Initial diagnosis requires exclusion of other etiologies and may include an upper endoscopy or gastrointestinal series