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Chronic condition characterized by intermittent, waxing and waning symptoms and signs of gastric or intestinal obstruction in the absence of any mechanical lesions
Caused by
Endocrine disorders (diabetes mellitus, hypothyroidism, cortisol deficiency)
Postsurgical (vagotomy, partial gastric resection, fundoplication, gastric bypass, Whipple procedure)
Neurologic conditions (Parkinson disease, muscular and myotonic dystrophy, autonomic dysfunction, multiple sclerosis, postpolio syndrome, porphyria)
Rheumatologic conditions (progressive systemic sclerosis)
Infections (postviral, Chagas disease)
Amyloidosis
Paraneoplastic syndromes
Medications
Anorexia nervosa
Cause may not always be identified
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Manifestations of gastroparesis may be chronic or intermittent
Early satiety, bloating, nausea, and vomiting (1–3 hours after meals), epigastric pain
Abdominal distention, vomiting, diarrhea, and malnutrition may be seen in those with small bowel involvement
Colonic involvement may cause constipation or alternating diarrhea and constipations
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Abdominal radiography shows dilatation of the stomach, esophagus, small intestine, or colon resembling ileus or mechanical obstruction
Endoscopy or CT or barium enterography excludes mechanical obstruction
Gastric scintigraphy with a low-fat solid meal assesses gastric emptying
Gastric retention of 60% of the meal after 2 hours or more than 10% after 4 hours is abnormal
Both a wireless motility capsule and a non-radioactive, 13-C labeled blue-green algae (Spirulina platensis) have been FDA approved to assess gastric emptying time
Small bowel manometry is useful
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No specific therapy
Acute exacerbations
Long-term treatment
Small, frequent meals low in fiber, fat, milk, and gas-forming foods
Well-tolerated foods include tea, ginger ale, soup, white rice, potatoes and sweet potatoes, fish, gluten-free foods, and applesauce
Jejunal feeding via external feeding tube or jejunostomy if oral feeding cannot meet nutritional needs
Parenteral nutrition seldom required unless there is a diffuse gastric and intestinal motility disorder
Avoid opioids and anticholinergics
In persons with diabetes, maintain glucose levels < 200 mg/dL
Metoclopramide
5–20 mg four times daily orally
5–10 mg intravenously or subcutaneously before meals
Discontinue after 3 months if neuromuscular side effects, particularly involuntary movements, develop
Domperidone
20–30 mg four times daily
Enhances gastric emptying and has efficacy as an antiemetic agent
Does not cause neuropsychiatric side effects because it does not cross the blood-brain barrier
Unavailable in the United States, but it is preferred therapy in most other countries where it is available
Prucalopride, 2 mg daily orally
Tradipitant, 85 mg twice daily orally (not yet FDA approved)
Venting gastrostomy may be needed in patients with predominant small bowel distention to relieve distress
Uncontrolled studies report symptom improvement with modalities that reduce intrapyloric pressure, including botulinum toxin injection, laparoscopic myotomy, and endoscopic myotomy