Gastroparesis: Difference between revisions
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==Causes of Non-obstructive delayed gastric emptying== | ==Causes of Non-obstructive delayed gastric emptying== | ||
*Idiopathic | *Idiopathic | ||
*[[ | *[[Diabetes mellitus]] | ||
*Postsurgical/Vagal nerve injury | *Postsurgical/Vagal nerve injury | ||
*GI disorders associated with delated gastric emptying | *GI disorders associated with delated gastric emptying | ||
| Line 18: | Line 18: | ||
**Celiac disease | **Celiac disease | ||
*Non-GI disorders associated with delayed gastric emptying | *Non-GI disorders associated with delayed gastric emptying | ||
**Eating disorders: [[Anorexia]] | **Eating disorders: [[Anorexia nervosa]] | ||
**Neurologic disorders such as parkinson's | **Neurologic disorders such as parkinson's | ||
**Collagen vascular disorders | **Collagen vascular disorders | ||
| Line 25: | Line 25: | ||
***Chronic renal insufficiency | ***Chronic renal insufficiency | ||
**Medication associated | **Medication associated | ||
***Most commonly used: Opioid analgesics, anticholinergics, progesterone, PPIs, alcohol, tobacco | ***Most commonly used: Opioid analgesics, anticholinergics, progesterone, PPIs, alcohol, tobacco | ||
==Clinical Features== | ==Clinical Features== | ||
Revision as of 02:17, 6 January 2017
Background
- Symptomatic chronic stomach disorder characterized by delayed gastric emptying without mechanical obstruction
- More common in women
- Gastric motility reduced by progesterone
- Vs. Functional dyspepsia
- Disease associated with reduced quality of life
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
- Depression
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