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Evaluation and Classification of Gastroparesis

  • Michael B. Goldberg
  • Eric G. SheuEmail author
Chapter

Abstract

Gastroparesis is a chronic and often debilitating disorder of the stomach characterized by delayed emptying without mechanical obstruction. It is an underrecognized and often undertreated disease often presenting with nausea, vomiting, bloating, and/or abdominal pain. The pathophysiology involves derangements of normal gastric motor function. The most common etiologies include idiopathic, diabetes, and postsurgical. In approximately one-half of gastroparetics, there is no identifiable cause. After ruling out mechanical obstruction with cross-sectional imaging and endoscopy, the diagnosis of gastroparesis is made with gastric emptying scintigraphy. This is a noninvasive and quantitative measurement of gastric emptying and is considered the gold standard for diagnosis. In this chapter we discuss the evaluation, workup, and classification of gastroparesis.

Keywords

Gastroparesis Gastric emptying Vagus nerve injury Diabetes complications Gastric outlet obstruction 

References

  1. 1.
    Jung HK, Choung RS, Locke GR 3rd, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225.CrossRefGoogle Scholar
  2. 2.
    Stein B, Everhart KK, Lacy BE. Gastroparesis: a review of current diagnosis and treatment options. J Clin Gastroenterol. 2015;49(7):550–8.CrossRefGoogle Scholar
  3. 3.
    Lacy BE, Crowell MD, Mathis C, Bauer D, Heinberg LJ. Gastroparesis: quality of life and health care utilization. J Clin Gastroenterol. 2018;52:20–4. [Epub ahead of print].PubMedGoogle Scholar
  4. 4.
    Carbone F, Tack J. Gastroduodenal mechanisms underlying functional gastric disorders. Dig Dis. 2014;32(3):222–9.CrossRefGoogle Scholar
  5. 5.
    Camilleri M, Malagelada JR, Brown ML, et al. Relation between antral motility and gastric emptying of solids and liquids in humans. Am J Phys. 1985;249(5 Pt 1):G580–5.Google Scholar
  6. 6.
    Mearin F, Camilleri M, Malagelada JR. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology. 1986;90(6):1919–25.CrossRefGoogle Scholar
  7. 7.
    Fraser RJ, Horowitz M, Maddox AF, et al. Postprandial antropyloroduodenal motility and gastric emptying in gastroparesis–effects of cisapride. Gut. 1994;35(2):172–8.CrossRefGoogle Scholar
  8. 8.
    Kumar A, Attaluri A, Hashmi S, et al. Visceral hypersensitivity and impaired accommodation in refractory diabetic gastroparesis. Neurogastroenterol Motil. 2008;20(6):635–42.CrossRefGoogle Scholar
  9. 9.
    Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108:18–37.CrossRefGoogle Scholar
  10. 10.
    Harberson J, Thomas R, Harbison S, et al. Gastric neuromuscluar pathology of gastroparesis: analysis of full-thickness antral biopsies. Dig Dis Sci. 2010;55:359–70.CrossRefGoogle Scholar
  11. 11.
    Parkman HP, Yates K, Hasler WL, et al. Similarities and differences between diabetic and idiopathic gastroparesis. Clin Gastroenterol Hepatol. 2011;9(12):1056–64.CrossRefGoogle Scholar
  12. 12.
    Soykan I, Sivri B, Sarosiek I, et al. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43:2398.CrossRefGoogle Scholar
  13. 13.
    Vittal H, Farrugia G, Gomez G, Pasricha PJ. Mechanisms of disease: the pathological basis of gastroparesis--a review of experimental and clinical studies. Nat Clin Pract Gastroenterol Hepatol. 2007;4:336.CrossRefGoogle Scholar
  14. 14.
    Hasler WL, Wilson LA, Parkman HP, et al. Bloating in gastroparesis: severity, impact, and associated factors. Am J Gastroenterol. 2011;106:1492–502.CrossRefGoogle Scholar
  15. 15.
    Sarosiek I, Davis B, Eichler E, McCallum RW. Surgical approaches to treatment of gastroparesis: gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes. Gastroenterol Clin N Am. 2015;44(1):151–67.  https://doi.org/10.1016/j.gtc.2014.11.012. Review.CrossRefGoogle Scholar
  16. 16.
    Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology. 2011;140:101–15.CrossRefGoogle Scholar
  17. 17.
    Pasricha PJ, Parkman HP. Gastroparesis: definitions and diagnosis. Gastroenterol Clin N Am. 2015;44(1):1–7.  https://doi.org/10.1016/j.gtc.2014.11.001. Review.CrossRefGoogle Scholar
  18. 18.
    Nguyen LA, Snape WJ Jr. Clinical presentation and pathophysiology of gastroparesis. Gastroenterol Clin N Am. 2015;44(1):21–30.  https://doi.org/10.1016/j.gtc.2014.11.003. Review.CrossRefGoogle Scholar
  19. 19.
    Cherian D, Sachdeva P, Fisher RS, Parkman HP. Abdominal pain is a frequent symptom of gastroparesis. Clin Gastroenterol Hepatol. 2010;8:676.CrossRefGoogle Scholar
  20. 20.
    Tougas G, Eaker EY, Abell TL, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95:1456.CrossRefGoogle Scholar
  21. 21.
    Shin AS, Camilleri M. Diagnostic assessment of diabetic gastroparesis. Diabetes. 2013;62(8):2667–73.  https://doi.org/10.2337/db12-1706. Review.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Parkman HP. Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and SmartPill. Gastrointest Endosc Clin N Am. 2009;19:49–55.CrossRefGoogle Scholar
  23. 23.
    Cassilly D, Kantor S, Knight L, et al. Gastric emptying of a nondigestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil. 2008;20(4):311–9.CrossRefGoogle Scholar
  24. 24.
    Kuo B, McCallum RW, Koch K, et al. Comparison of gastric emptying of a nondigestible capsule to a radiolabeled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2008;27(2):186–96.CrossRefGoogle Scholar
  25. 25.
    Szarka LA, Camilleri M, Vella A, et al. A stable isotope breath test with a standard meal for abnormal gastric emptying of solids in the clinic and in research. Clin Gastroenterol Hepatol. 2008;6(6):635–43.CrossRefGoogle Scholar
  26. 26.
    Hasler WL. Gastroparesis: pathogenesis, diagnosis, and management. Nat Rev Gastroenterol Hepatol. 2011;8:438–53.CrossRefGoogle Scholar

Copyright information

© SAGES 2019

Authors and Affiliations

  1. 1.Department of SurgeryBrigham and Women’s HospitalBostonUSA
  2. 2.Assistant Professor of Surgery, Harvard Medical School; Associate Surgeon, Division of General and Gastrointestinal SurgeryBrigham and Women’s HospitalBostonUSA

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