Gastroparesis, a common event in persons with diabetes mellitus and functional dyspepsia, is defined as delayed gastric emptying. The major etiologic categories are diabetic, idiopathic, and postsurgical. The American Gastroenterological Association issued a medical position statement on the diagnosis and treatment of gastroparesis. The diagnosis is based on appropriate symptoms and signs of gastric dysmotility, delayed gastric emptying, and the absence of obstructing structural upper gastrointestinal lesions. The most common presenting symptoms include nausea, vomiting, and postprandial abdominal fullness. These symptoms can overlap with functional dyspepsia, sometimes caused by idiopathic gastroparesis, in which a person notes upper abdominal pain or discomfort possibly associated with early satiety, nausea, and postprandial fullness.
Delayed gastric emptying is best diagnosed by gastric emptying scintigraphy performed for two hours after ingesting a radiolabeled meal. Longer duration testing may have a higher yield. Antroduodenal manometry measuring the coordination of gastric and duodenal motor function during fasting and postprandial periods may show decreased antral contractility and increased motor activity in the small intestine compared with the stomach in gastroparesis.
The treatment of gastroparesis includes dietary instruction and prescribing of antiemetics and prokinetic pharmacologic agents. Diet changes should include eating multiple smaller meals and replacing solids with liquids such as soup. Lowering fat and fiber intake also may be helpful. Commonly used antiemetics for the treatment of nausea and vomiting include prochlorperazine (Compazine), trimethobenzamide (Tigan), and promethazine (Phenergan). Serotonin receptor antagonists commonly used in managing chemotherapy-induced nausea and vomiting also may be useful. Prokinetic agents, including metoclopramide (Reglan) and erythromycin, can be administered orally or intravenously. Multiple treatments are available for refractory gastroparesis sufferers (see accompanying table).
The authors conclude that the current management of gastroparesis is suboptimal. Future developments may include novel prokinetic agents, fundic relaxing agents that improve accommodation and diminish early satiety, gastric slow wave antidysrhythmic medications that stabilize slow wave activity resulting in symptom improvement, and alternative and unconventional medical therapies such as ginger, hypnotherapy, biofeedback, standard acupuncture or acupressure, and electroacupuncture.
|Switching prokinetic and/or antiemetic agents|
|Combining prokinetic agents|
|Injecting botulinum toxin into the pylorus|
|Using gastrostomy or jejunostomy tubes|
|Implanting a gastric electric stimulator|
|Using surgical treatment as a last resort|