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Gastroesophageal Reflux Disease

1. What is gastroesophageal reflux disease ( GERD )? GERD develops when the reflux of stomach contents causes troublesome symptoms or complications. This means that GERD is defined by a constellation of both symptoms or objective findings such as esophageal erosions or Barrett’s esophagus. 2. Is GERD a common disease ? GERD is one of the most common disorders of the gastrointestinal tract. In developed countries,…

Resources for the gastroparesis patient

Introduction Gastroparesis, also called delayed gastric emptying, is a chronic digestive condition where the stomach fails to properly empty, causing sometimes debilitating symptoms, including nausea, vomiting, pain, and distention/bloating, which persist or reoccur long-term. It can significantly interfere with the daily living and quality of life of those affected. While the incidence and prevalence of gastroparesis are not well-defined, it is estimated to affect up to…

A vision of the future for gastroparesis

Introduction In gastroparesis, there is abnormal function of extrinsic vagal innervation, smooth muscle, enteric nervous system, or pacemakers in the stomach wall, specifically, the interstitial cells of Cajal (ICCs) or fibroblast-like cells that have receptors for platelet-derived growth factor α. The delay of gastric emptying in gastroparesis is associated with distal antral hypomotility, pylorospasm, or intestinal dysmotility. In general, antral hypomotility is usually present when there…

Cell transplantation for gastroparesis

Introduction Normal gastric motor function requires coordinated interaction between the central nervous system (CNS), the enteric nervous system (ENS), interstitial cells of Cajal (ICC), and smooth muscle cells (SMCs). Gastroparesis is a multifactorial neuromuscular disorder involving dysfunction at various levels of this network. For example, vagal dysfunction, disruption of the ENS (particularly loss of nitrergic neurons), smooth muscle abnormalities, and deficits in ICC networks have all…

A brief history and future directions of permanent, temporary, and endoscopic GES

Introduction Gastroparesis (Gp) is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction and it is associated with symptoms of early satiety, nausea, vomiting, abdominal pain, and bloating. However, these identical symptoms can occur in patients without delayed, or even with rapid gastric emptying. For that reason, some have advocated using the term gastroparetic syndromes. While most Gp is idiopathic, diabetes, post-surgical,…

Female predominance in gastroparesis

Key points Epidemiological studies show that the incidence of gastroparesis in women is four times higher than men. Female sex hormones fluctuate during different hormonal stages including the menstrual cycle, pregnancy, and menopause raising the theory that differences in gonadal steroid hormones may play a role in the pathophysiology of the female predominance in gastroparesis. Estrogen can modulate the biochemical function of neuronal nitric oxide synthase…

Distinguishing between functional dyspepsia and gastroparesis: Does it matter?

Case study HM is a 34 year old woman sent for a third opinion in gastroenterology. Her symptoms include near daily nausea, epigastric fullness, early satiety and bloating. Symptoms started two years ago after she, and the rest of the family, all developed a severe gastroenteritis. She was well before that without any significant medical, surgical, family or psychological history. Initial symptoms included daily nausea and…

Endoscopic full-thickness gastric biopsy: Ready for prime time?

Abbreviations EFTB endoscopicfull-thickness biopsy EMR endoscopic mucosal resection FTRD full-thickness resection device ICC interstitial cells of Cajal MP muscularis propria OTSC over-the-scope-clip Introduction Gastroparesis is a syndrome of delayed gastric emptying in the absence of mechanical obstruction. Common symptoms of the disease include early satiety, postprandial fullness, nausea, vomiting, bloating and upper abdominal pain . The most common etiologies for gastroparesis are idiopathic, diabetic and surgical,…

The pyloric revolution: Patient selection

Introduction The sine qua non of gastroparesis is delayed gastric emptying but as currently defined, gastroparesis is likely a heterogeneous disorder in which symptom pathogenesis is triggered by multiple discrete and connected mechanisms, with delayed gastric emptying representing an epiphenomenon of gastric dysfunction rather than the dominant source of symptoms in many affected patients. In addition to impaired gastric emptying, subsets of affected patients have been…

Evaluating response in gastroparesis: Patient reported outcome measures and survey instruments

Introduction Gastroparesis is a symptomatic condition of delayed gastric emptying with no mechanical obstruction . There are several etiologies of gastroparesis, including diabetic gastroparesis and postsurgical gastroparesis. In many patients, a cause cannot be found, and the condition is termed idiopathic gastroparesis. In some of these patients, a viral etiology may be suspected due to a sudden onset of symptoms associated with a viral-like prodrome. A…

Studies from the NIH Gastroparesis Clinical Research Consortium: Towards improving our understanding and treatment of gastroparesis

Introduction The NIH Gastroparesis Clinical Research Consortium (GpCRC) was started in 2005 to improve the understanding of the pathogenesis and natural history of gastroparesis of all etiologies and to advance the diagnosis and therapy of patients affected with this troubling condition. The consortium initially consisted of five centers along with the data coordinating center and the NIH. Over the initial 13 years of study from a…

Surgical management of gastroparesis

Introduction Gastroparesis (GP) is a disorder of delayed gastric emptying in the absence of mechanical obstruction that manifests with abdominal pain, nausea/vomiting, bloating and early satiety. Total or subtotal gastrectomy is indicated only as the final step in the GP subset of patients (<5%) whose vomiting has not responded to all medical therapies including PP and GES. However, extensive gastric resection surgery has complications, including long-term…

Gastric electrical stimulation for gastroparesis

Key points (1) Gastric electrical stimulation (GES) is a therapy providing neurostimulation via two electrodes implanted in the gastric smooth muscle. (2) The predominant mechanism of action of GES is by central control of nausea and vomiting by affecting the chemoreceptor trigger zone, and it also enhances vagal nerve function. (3) The most important effect of GES is its powerful antiemetic mechanism, which is beneficial when…

Enteric tube placement for gastroparesis: Gastrostomy, gastrojejunostomy and jejunostomy

Introduction Gastroparesis can be a debilitating condition that affects patient quality of life. Over the past two decades, there has been a dramatic increase in hospital admissions and health care expenses due to gastroparesis and its complications . This chapter will focus on malnutrition and the options for enteral feeding techniques that with the aim of maximizing nutrition and improving symptoms. When oral diet is not…

Alternative, complementary medicine and cannabinoids for gastroparesis

Introduction Gastroparesis (GP) is a complicated and multi-factorial disorder associated with variable symptoms of nausea, vomiting, early satiety, upper abdominal pain, post-prandial fullness, bloating, and/or belching . Although these symptoms may be associated with chronic diseases such as diabetes, Parkinson’s, and collagen vascular diseases, as well as certain medications (i.e., narcotics, muscarinic cholinergic antagonists, tricyclic antidepressants ), and surgery (i.e. fundoplication leading to vagus nerve injury),…

Psychiatric aspects of gastroparesis

The term “gastroparesis” implies a partial or complete paralysis of the stomach as a result of muscle or nerve dysfunction. As this book will attest, gastroparesis is far more complex than this simple definition. Gastric emptying time may be normal and yet the patient may respond to the same treatments that work for other patients with study proven delayed gastric emptying. Is gastroparesis caused by dysbiosis,…

Abdominal pain in gastroparesis: Prevalence, potential causes and management

Although nausea, vomiting, early satiety, and postprandial fullness are the main symptoms of gastroparesis, abdominal pain can be a prominent symptom in some patients with gastroparesis. Treatment of abdominal pain in patients with gastroparesis can be particularly difficult, as often the cause of the pain is not known and some of the treatments used for the pain may impact adversely on gastric emptying and other symptoms…