Definition: Delayed gastric emptying without mechanical obstruction of the stomach or duodenum.
H&P performed, see above.
Patient educated about the condition, alternative treatments, risks, and benefits provided.
The patient has symptoms of gastroparesis. Will get gastric emptying scintigraphy to confirm the diagnosis. Both symptoms and gastric emptying study are required to make the diagnosis.
Step 1: TSH, CBC (evaluate for infection or cancer), Amylase to r/o pancreatitis if abdominal pain is present.
Step 2: EGD – Get EGD to r/o mechanical obstruction of the stomach or duodenum.
Step 3: Gastric emptying scintigraphy after a solid meal (is the preferred diagnostic test for gastroparesis).
Treatment:
-D/C medications that slow gastric emptying
-Take smaller, more frequent meals (as many as 6-8 per day) and take in more calories in semisolid or liquid form.
-Avoid solid fats b/c they slow gastric emptying. Prefer liquid fats.
-Avoid high fiber diets because fiber slows gastric emptying and may form bezoars.
-Control blood sugars.
–Metoclopramide (a prokinetic) will be used since that is the first line tx for gastroparesis. Rx: Metoclopramide (Reglan) 10 mg PO four times per day.
-Symptom severity will be assessed using the Gastroparesis Cardinal Symptom Index (GCSI), which is a validated scoring system, and the Abell’s scoring system, which has yet to be validated.
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Other Useful Information
-Other prokinetics that work are Erythromycin and Domperidone. Gastric electric stimulation also works.
-Several scoring systems are available for accessing the severity of gastroparesis. Two of the most commonly used ones are the Gastroparesis Cardinal Symptom Index (GCSI), which is a validated scoring system, and the Abell’s scoring system, which has yet to be validated.
Metoclopramide a prokinetic serotonin 5-HT3 receptor antagonist and dopamine D2 receptor antagonist that works by coordinating gastrointestinal muscular contractions.
** “Obesity in patients with type 2 diabetes increases the risk of gastroparesis”
References:
Clin Exp Gastroenterol. 2013; 6: 161–165.
Am Fam Physician. 2016 Dec 15;94(12):980-986.
Am Fam Physician. 2008 Jun 15;77(12):1697-1702.
https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis (Accessed 4/20/2017)