Gastroparesis: Difference between revisions
 
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==Background==
==Background<ref>Parkman HP, Hasler WL, Fisher RS. American Gastroenterlogical Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004; 127(5): 1592-1622.</ref>==
*Chronic GI disorder characterized by delayed gastric emptying ''without'' mechanical obstruction  
*Chronic GI disorder characterized by delayed gastric emptying ''without'' mechanical obstruction  
*More common in women, presumed due to elevated progesterone
*More common in women, presumed due to elevated progesterone
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*GI disorders associated with delayed emptying:
*GI disorders associated with delayed emptying:
**[[GERD]], [[Achalasia]]
**[[GERD]], [[Achalasia]]
**Atrophic gastritis, celiac disease
**Atrophic [[gastritis]], celiac disease
**Functional dyspepsia
**Functional [[dyspepsia]]
**Hypertrophic [[Pyloric stenosis]]
**Hypertrophic [[pyloric stenosis]]
*Non-GI conditions/risk factors associated with delayed gastric emptying
*Non-GI conditions/risk factors associated with delayed gastric emptying
**Medications: [[opioids]], [[anticholinergics]], [[PPI]]s, [[alcohol]], tobacco, progesterone
**Medications: [[opioids]], [[anticholinergics]], [[PPI]]s, [[alcohol]], tobacco, progesterone
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***Gastric outlet obstruction/[[Pyloric stenosis]]
***Gastric outlet obstruction/[[Pyloric stenosis]]
***[[Volvulus]]
***[[Volvulus]]
***Strangulated hernia
***Strangulated [[hernia]]
**[[Pancreatitis]]
**[[Pancreatitis]]
**[[Appendicitis]]
**[[Appendicitis]]
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**[[Spontaneous bacterial peritonitis]]
**[[Spontaneous bacterial peritonitis]]
**[[Urinary tract infection]]
**[[Urinary tract infection]]
**Bacterial toxins, Viruses (adeno, norwalk, rota)
**[[bacterial disease|Bacterial]] toxins, [[viruses]] ([[adenovirus]], [[norovirus]], [[rotavirus]])
*Drugs/Toxins
*Drugs/Toxins
**[[Heavy metal poisoning]]
**[[Heavy metal toxicity]]
**[[Methanol poisoning]]
**[[Methanol toxicity]]
*Endocrine
*Endocrine
**[[Diabetic ketoacidosis]]
**[[Diabetic ketoacidosis]]
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==Evaluation==
==Evaluation==
[[File:GastroparesisXray.jpg|thumb|Simple abdominal X-ray reveals a large amount of material in the stomach, suggesting severe gastric hypomotility.]]
*Definitive diagnosis of gastroparesis not typically made in ED
*Definitive diagnosis of gastroparesis not typically made in ED
**Gold standard is gastric emptying scintigraphy of a solid-phase meal
**Gold standard is gastric emptying scintigraphy of a solid-phase meal
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*[[Urinalysis]], uHCG
*[[Urinalysis]], uHCG
*Consider:  
*Consider:  
**ECG (if >50 or at risk for cardiac disease)
**[[ECG]] (if >50 or at risk for cardiac disease)
**[[RUQ US]]
**[[RUQ US]]
**Acute abdominal series including an upright CXR (if risk for perforated ulcer)
**[[Acute abdominal series]] including an upright CXR (if risk for perforated ulcer)
**CT abdomen/pelvis to rule out obstruction
**CT abdomen/pelvis to rule out obstruction
**Upper endoscopy or radiographic upper GI series to exclude mechanical obstruction or ulcer disease
**Upper endoscopy or radiographic upper GI series to exclude mechanical obstruction or ulcer disease
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*[[IVF]], [[Electrolyte repletion]]
*[[IVF]], [[Electrolyte repletion]]
*[[Antiemetics]]
*[[Antiemetics]]
**Dopamine receptor antagonists: [[Prochlorperazine]], [[promethazine]], trimethobenzamide
**Dopamine receptor antagonists: [[Haloperidol]], [[Prochlorperazine]], [[promethazine]], trimethobenzamide
***[[Haloperidol]] has been shown to reduce the rate of admission and morphine equivalent doses of analgesia<ref>Ramirez R, Stalcup P, Croft B, Darracq MA. Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department. Am J Emerg Med. 2017;35(8):1118-1120. doi:10.1016/j.ajem.2017.03.015</ref>
**[[Ondansetron]]
**[[Ondansetron]]
*Prokinetic agents: enhance gut contractility
*Prokinetic agents: enhance gut contractility
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*Refractory disease:  
*Refractory disease:  
**[[Nasogastric tube]] to decompress stomach
**[[Nasogastric tube]] to decompress stomach
**Advanced therapies (not in ED) may include: placement of jejunostomy and/or [[G-tube complications|gastrostomy tube]], pyloric injection of botulinum toxin, [[Gastric pacemaker complication|gastric electric stimulation]
**Advanced therapies (not in ED) may include: placement of jejunostomy and/or [[G-tube complications|gastrostomy tube]], pyloric injection of botulinum toxin, [[Gastric pacemaker complication|gastric electric stimulation]]
*Prevention of future exacerbations:
*Prevention of future exacerbations:
**Review medications,  [[opioids]], [[anticholinergics]], [[PPI]]s may worsen or trigger symptoms
**Review medications,  [[opioids]], [[anticholinergics]], [[PPI]]s may worsen or trigger symptoms
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==References==
==References==
<references/>
<references/>
*1. Parkman HP, Hasler WL, Fisher RS. American Gastroenterlogical Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004; 127(5): 1592-1622.
 


[[Category:GI]]
[[Category:GI]]

Latest revision as of 00:49, 1 February 2024

Background[1]

  • Chronic GI disorder characterized by delayed gastric emptying without mechanical obstruction
  • More common in women, presumed due to elevated progesterone
  • Symptoms overlap with functional dyspepsia

Causes of Non-Obstructive Delayed Gastric Emptying

Clinical Features

Differential Diagnosis

Nausea and vomiting

Critical

Emergent

Nonemergent

Gastroparesis (by organ system)

Evaluation

Simple abdominal X-ray reveals a large amount of material in the stomach, suggesting severe gastric hypomotility.
  • Definitive diagnosis of gastroparesis not typically made in ED
    • Gold standard is gastric emptying scintigraphy of a solid-phase meal
    • Other studies assessing emptying: tests, upper GI barium study, ultrasound for changes in antral area
  • ED workup to exclude alternative diagnoses and complications (e.g. dehydration, Electrolyte abnormalities)
  • CBC, BMP, LFTs, lipase
  • Urinalysis, uHCG
  • Consider:
    • ECG (if >50 or at risk for cardiac disease)
    • RUQ US
    • Acute abdominal series including an upright CXR (if risk for perforated ulcer)
    • CT abdomen/pelvis to rule out obstruction
    • Upper endoscopy or radiographic upper GI series to exclude mechanical obstruction or ulcer disease

Management

ED Management

Complications

Disposition

  • Discharge with outpatient follow up unless:
    • Inability to tolerate PO
    • Need for ongoing IV rehydration, electrolyte correction, and/or glycemic control

See Also

External Links

References

  1. ↑ Parkman HP, Hasler WL, Fisher RS. American Gastroenterlogical Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004; 127(5): 1592-1622.
  2. ↑ Ramirez R, Stalcup P, Croft B, Darracq MA. Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department. Am J Emerg Med. 2017;35(8):1118-1120. doi:10.1016/j.ajem.2017.03.015
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