Gastroparesis
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Synopsis
Gastroparesis is a disorder of delayed gastric emptying not caused by mechanical obstruction. Patients present with nausea, emesis, early satiety, bloating, and sometimes abdominal pain.
There are numerous etiologies of gastroparesis, but it is most commonly idiopathic. Diabetes mellitus as a cause of gastroparesis is increasing in prevalence. Additional etiologies include postsurgical vagal nerve injury, medication adverse effects, and other neurodegenerative or autoimmune diseases (eg, parkinsonism, AIDS, scleroderma). Narcotics, calcium channel blockers, glucagon-like peptide-1 (GLP-1) antagonists, tricyclic antidepressants, octreotide, phenothiazines, and cyclosporine are medications that frequently cause delayed gastric emptying.
Evaluation for suspected gastroparesis may include imaging to exclude a bowel obstruction and a detailed history to delineate alternative causes of the patient's symptoms, which are nonspecific and overlap with numerous gastrointestinal conditions. Physical examination is often normal but may demonstrate a protuberant abdomen and a succussion splash.
There are numerous etiologies of gastroparesis, but it is most commonly idiopathic. Diabetes mellitus as a cause of gastroparesis is increasing in prevalence. Additional etiologies include postsurgical vagal nerve injury, medication adverse effects, and other neurodegenerative or autoimmune diseases (eg, parkinsonism, AIDS, scleroderma). Narcotics, calcium channel blockers, glucagon-like peptide-1 (GLP-1) antagonists, tricyclic antidepressants, octreotide, phenothiazines, and cyclosporine are medications that frequently cause delayed gastric emptying.
Evaluation for suspected gastroparesis may include imaging to exclude a bowel obstruction and a detailed history to delineate alternative causes of the patient's symptoms, which are nonspecific and overlap with numerous gastrointestinal conditions. Physical examination is often normal but may demonstrate a protuberant abdomen and a succussion splash.
Codes
ICD10CM:
K31.84 – Gastroparesis
SNOMEDCT:
235675006 – Gastroparesis
K31.84 – Gastroparesis
SNOMEDCT:
235675006 – Gastroparesis
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Diagnostic Pearls
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Differential Diagnosis & Pitfalls
- Gastritis
- Esophageal spasm (see esophageal motility disorder)
- Hiatal hernia
- Celiac disease
- Small bowel intestinal overgrowth
- Achalasia (see esophageal motility disorder)
- Mesenteric ischemia
- Crohn disease
- Malignancy (particularly esophageal, gastric, small bowel, colonic, pancreatic, liver)
- Biliary colic / cholelithiasis
- Zollinger-Ellison syndrome
- Celiac disease
- Tropical sprue
- Chronic pancreatitis
- Irritable bowel syndrome
- Uterine fibroids (leiomyoma)
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Management Pearls
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Therapy
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Drug Reaction Data
Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.
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References
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Last Reviewed:09/26/2017
Last Updated:01/18/2021
Last Updated:01/18/2021