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Antiemetic therapy for gastroparesis

Gastroparesis is a heterogeneous syndrome with variable clinical manifestations. Some patients present with regurgitation-predominant symptoms suggestive of gastroesophageal reflux disease, but effortless regurgitation of undigested foods after meals and at night should suggest gastroparesis . Other patients may have prominent postprandial epigastric discomfort, early satiety and bloating, distinguishable from functional dyspepsia . The most recognized symptoms of gastroparesis are chronic or episodic nausea, retching, and emesis,…

Prokinetic agents for gastroparesis

Introduction Gastroparesis is a chronic disorder characterized by delayed gastric emptying in the absence of mechanical obstruction . The diagnosis of gastroparesis is confirmed in a symptomatic patient by demonstrating delayed gastric emptying with no organic lesions on upper endoscopy such as ulceration or pyloric stenosis. Gastroparesis can occur in several clinical settings; it is commonly associated with diabetes, post-gastric surgical conditions, and idiopathic (that is,…

Dietary therapy for gastroparesis

The digestive roles of the stomach The efficacy of nutrition therapy for gastroparesis is rooted in an understanding of the two predominant functions of the stomach: (1) it serves as a reservoir for ingested food, and (2) it grinds, mixes, and triturates that food into particles small enough to enter the small intestine. To accommodate ingested food, the fundus relaxes and expands from 50 mL to…

Pediatric gastroparesis

Abbreviations GP gastroparesis ICCs interstitial cells of Cajal GCSI Gastroparesis Cardinal Symptoms Index PAGI-QOL Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life GES gastric emptying scintigraphy WMC wireless motility capsule EGD esophagogastroduodenoscopy EGG electrogastrography Introduction Gastroparesis ( GP ) is defined as delayed gastric emptying of fluids and/or solids in the absence of a mechanical obstruction . GP has been extensively studied in the adult population…

Gastroparesis from other causes

Introduction The most common etiologies of gastroparesis are typically understood to be post-infectious, post-operative, diabetic, and idiopathic (the latter often overlapping with post-infectious gastroparesis, which can be difficult to identify confidently by clinical history). Case series often frame idiopathic gastroparesis as the single most common etiologic category . There are, however, a variety of less common pathophysiologic mechanisms by which gastric motor function can be disturbed…

Idiopathic gastroparesis

Introduction Idiopathic gastroparesis (IG) is defined as delayed gastric emptying with associated symptoms thereof without an identifiable cause. Although more than 90 possible causes of gastroparesis have been identified in the literature including case reports, the most common subsets are idiopathic, diabetic, and postsurgical with idiopathic accounting for up to 50–60% of cases . Women are primarily affected with a significant margin of up to 4:1…

Postsurgical gastroparesis

Introduction Postsurgical gastroparesis (PSG) is a syndrome of objectively delayed gastric emptying without mechanical obstruction following a surgical intervention on the stomach or esophagus. It most commonly results from a surgical disruption of the vagal pathways innervating the stomach and pylorus. The symptoms most commonly associated with the syndrome are early satiety, nausea, vomiting, abdominal pain and bloating occurring early after a foregut operation. Classically, PSG…

Diabetic gastroparesis

Introduction Type 1 and type 2 diabetes are associated with a variety of symptoms at all levels of the gastrointestinal tract, a phenomenon documented by Rundles as early as 1945 . Probably the best known gastrointestinal complication of diabetes is gastroparesis, and diabetes is the underlying cause in about one-third of patients attending specialist centers with a diagnosis of gastroparesis . The first detailed description of…

Ancillary testing including barostat, SPECT, and satiety testing

Introduction Gastroparesis presents with cardinal symptoms suggestive of delayed gastric emptying including nausea, vomiting, early satiety, postprandial fullness, bloating, visible distention, and upper abdominal pain. The diagnosis is made by documenting delays in gastric emptying on scintigraphy, breath testing, or wireless motility capsule testing. Depending on the methods used, delayed emptying is demonstrated in only 25–36% of patients with suspected gastroparesis . Those patients without gastric…

Antroduodenal manometry for the evaluation of patients with suspected gastroparesis

Background This chapter will discuss the possible use and importance of antroduodenal manometry in the diagnosis and treatment of gastroparesis. As discussed in other chapters, gastroparesis is defined by symptoms of nausea, vomiting and abdominal pain. Generally there is a delay in the emptying of the stomach. There is a question as to whether these symptoms and signs are (1) due to an alteration in contractions…

Electrogastrography for suspected gastroparesis

Introduction Electrogastrography refers to the noninvasive method for recording and analyzing gastric myoelectrical activity (GMA) from electrodes placed on the upper abdominal surface . Electrogastrography methods are used to record electrogastrograms (EGGs) which measure GMA. The normal frequency of GMA in humans is approximately 3 cycles per minute (cpm) . The EGG signal measures GMA which includes ongoing gastric slow waves and the plateau and action…

Magnetic resonance imaging for gastric motility and function

Magnetic resonance imaging for gastric motility and function Magnetic resonance imaging (MRI) is a valuable tool for visualization of the anatomy and the function of the digestive system in health and disease . Use of MRI in assessment of gastric physiology was proposed and validated against gastric scintigraphy and intraluminal pressure measurement (barostat, manometry) in the 1990s and 2000s . Since then studies have demonstrated its…

Breath tests for the assessment of gastroparesis

Introduction Many providers are often faced with the decision of selecting the best test available from their armamentarium to diagnose gastroparesis. This can be challenging with recent evidence showing poor correlation between symptom relief and gastric emptying . There are currently many options on the market, as discussed in other chapters. The Breath Test for gastroparesis is one of the newer tests for gastroparesis available to…

The use of wireless motility capsule in the diagnosis and monitoring of gastroparesis

Gastroparesis Background Gastroparesis is a chronic disorder characterized by delayed gastric emptying in the absence of mechanical obstruction, which results in typical symptoms of nausea, vomiting, bloating, abdominal distention, postprandial fullness, early satiation, and upper abdominal pain . Population-based studies have estimated the age-adjusted incidence rate of gastroparesis to be 2.4 patients per 100,000 person-years for men and 9.8 patients per 100,000 person-years for women, while…

Gastric emptying scintigraphy

Introduction Gastric motility is important for the proper processing and gastric emptying (GE) of an ingested meal . The gastric motility responses to an ingested meal involve actions of several different regions of the stomach. These include initial proximal gastric fundic relaxation and accommodation of the meal followed by subsequent tonic fundic contractions. This is followed by the onset of distal antral phasic contractions which grind…

Autonomic neuropathies and gastroparesis

Abbreviations AAG Autonomic autoimmune ganglionopathy ANS Autonomic nervous system ATTR Transthyretin amyloid COMPASS composite autonomic symptom score EDS Ehlers-Danlos syndrome HIV Human Immunodeficiency Virus POTS Postural orthostatic tachycardia syndrome TTR Transthyretin Introduction The autonomic nervous system (ANS) consist of the sympathetic, the parasympathetic and the enteric nervous systems. The enteric nervous system consists of its own functional units with the interstitial cells of Cajal, Meissner and…

Gastroparesis and the brain-gut axis

Introduction Gastroparesis causes impairment in quality of life with deleterious impacts on health. Complicating our understanding of the condition is the combination of different insults which can provoke the disorder. No matter the etiology, it is likely that virtually all gastroparesis patients do suffer from perturbations in the brain-gut innervation derived from the vagus nerve and/or the enteric nervous system. While traditionally management of impaired brain-gut…

Pathology of gastroparesis: ICC, enteric neurons and fibrosis

Introduction Gastroparesis is a disease that affects the stomach’s motility and digestion, preventing proper stomach emptying. As a complex organ, the stomach empties both solid food and liquids at different rates, with liquids normally emptying faster than solids. In the absence of obvious mechanical outlet obstruction, gastroparesis is classified as delayed emptying of food from the stomach into the small intestine . Gastroparesis is a distressingly…

Sensory dysfunction in gastroparesis

Gastroparesis occurs commonly as a complication of long-standing diabetes, but the in the largest group of patients no cause can be established and these are referred to as idiopathic gastroparesis patients. While delayed gastric emptying is a defining feature of gastroparesis, gastric emptying rate is inconsistently linked with symptoms and choice of or response to therapy. Hence, there are other mechanisms contributing to the pathophysiology of…

Cellular pathogenesis of gastroparesis

Abbreviations Ano-1 anoctamin-1 BH4 tetrahydrobiopterin BMP-2 bone morphogenetic protein-2 BMPR BMP receptor ChAT choline acetyltransferase CSF-1 colony stimulating fator-1 CX3CR1 CX3C chemokine receptor 1 DG diabetic gastroparesis DM diabetes mellitus ENS enteric nervous system GI gastrointestinal HO-1 heme oxygenase 1 ICC interstitial cells of Cajal IG idiopathic gastroparesis IGF-1 insulin like growth factor 1 IL-1β interleukin 1β iNOS inhibitory nitric oxide synthase IP3 inositol triphosphate MHCII…