Skip to main content
SpringerLink
Log in

Gastroparesis in Older Adults

  • Reference work entry
  • First Online:
Geriatric Gastroenterology

  • 204 Accesses

Abstract

Gastroparesis is a debilitating condition in which delayed gastric emptying is associated with a constellation of symptoms (nausea, vomiting, boating, abdominal pain, etc.) in the absence of mechanical obstruction. Gastric motility changes with aging; however, significant impairment of gastric emptying is not a normal physiologic aging process. Different causes may contribute to gastroparesis in the older population. The most common etiologies in all subgroups of ages are diabetes, idiopathic, and postsurgical, but certain common disorders (medication side effects and neurological conditions) in the geriatric population warrant special emphasis. Management involves dietary modifications, combinations of antiemetics and prokinetics cautiously selected to minimize likelihood of adverse events. Other treatment options should be cautiously selected in this particular population.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution

Institutional subscriptions

Similar content being viewed by others

References

  • Abell TL, Van Cutsem E, Abrahamsson H, et al. Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion. 2002;66:204–12.

    Article  PubMed  Google Scholar 

  • Abell T, McCallum RW, Hocking M, et al. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology. 2003;125:421–8.

    Article  PubMed  Google Scholar 

  • Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and Society of Nuclear Medicine. Am J Gastroenterol. 2008;103:753–63.

    Article  PubMed  Google Scholar 

  • Ahluwalia NK, Thompson DG, Barlow J. Effect of distension and feeding on phasic changes in human proximal gastric tone. Gut. 1996;39:757–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Anand C, Al- Juburi A, Familoni B, et al. Gastric electric stimulation is safe and effective: a long-term study in patients with refractory gastroparesis in three reginal centers. Digestion. 2007;75:83–9.

    Article  PubMed  Google Scholar 

  • Arts J, Holvoet L, Caenepeel P, et al. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007;26:1251–8.

    Article  CAS  PubMed  Google Scholar 

  • Bizer E, Harrell S, Koopman J, et al. Obesity is common in gastroparesis despite nausea, vomiting, and early satiety. Gastroenterology. 2005;128:M1895.

    Google Scholar 

  • Bouras EP, Talley NJ, Camilleri M, et al. Effects of amitriptyline on gastric sensorimotor function and postprandial symptoms in healthy individuals: a randomized, double-blind, placebo-controlled trial. Am J Gastroenterol. 2008;103:2043.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Camilleri M. Integrated upper gastro-intestinal response to food intake. Gastroenterology. 2006;131:640–58.

    Article  CAS  PubMed  Google Scholar 

  • Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108:18.

    Article  CAS  PubMed  Google Scholar 

  • Carmel R, Aurangzeb I, Qian D. Associations of food-cobolamin malabsorption with ethnic origin, age, Helicobacter pylori infection, and serum markers of gastritis. Am J Gastroenterol. 2001;96:63–70.

    Article  CAS  PubMed  Google Scholar 

  • Clarkston WK, Pantano MM, Morley JE, et al. Predictors of gastric emptying in Parkinson’s disease. Neurogastroenterol Motil. 2006;18:369–75.

    Article  Google Scholar 

  • Colemont LJ, Camilleri M. Chronic intestinal pseudo-obstruction: diagnosis and treatment. Mayo Clin Proc. 1989;64:60–70.

    Article  CAS  PubMed  Google Scholar 

  • Davis BR, Sarosiek I, Bashashati M, et al. The long-term efficacy and safety of pyloroplasty combined with gastric electrical stimulation therapy in gastroparesis. J Gastrointest Surg. 2017;21(2):222–7.

    Article  PubMed  Google Scholar 

  • De Giorgio R, Guerrini S, Barbara G, et al. Inflammatory neruopathies of the enteric nervous system. Gastroenterology. 2004;126(7):1872–83.

    Article  PubMed  Google Scholar 

  • Delegado-Aros S, Camilleri M, Cremonnini F, et al. Contributions of gastric volumes and gastric emptying to meal size and post meal symptoms in functional dyspepsia. Gastroenterology. 2004;127(6):1685–94.

    Article  Google Scholar 

  • Dumitrascu DL, Barnet J, Kirschner T, et al. Antral emptying of semisolid meal measured by real-time ultrasonography in chronic renal failure. Dig Dis Sci. 1995;40:636–44.

    Article  CAS  PubMed  Google Scholar 

  • Ebert EC. The thyroid and the gut. J Clin Gastroenterol. 2010;44(6):402–6.

    Article  CAS  PubMed  Google Scholar 

  • Evans MA, Triggs EJ, Cheung M, et al. Gastric emptying rate in the elderly: implications for drug therapy. J Am Geriatr Soc. 1981;29(5):201–5.

    Article  CAS  PubMed  Google Scholar 

  • Familoni BO, Abell TL, Voeller G, et al. Electrical stimulation at a frequency higher than basal rate in human stomach. Dig Dis Sci. 1997;42:885–91.

    Article  CAS  PubMed  Google Scholar 

  • Forster J, Sarosiek I, Delcore R, et al. Gastric pacing is a new surgical treatment for gastroparesis. Am J Surg. 2001;182:676–81.

    Article  CAS  PubMed  Google Scholar 

  • Freiedenberg FK, Palit A, Parkman HP, Hanlon A, Nelson D. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103:416–23.

    Article  CAS  Google Scholar 

  • Gilsdorf D, Volckmann E, Brickley A, et al. Pyloroplasty offers relief of postfundoplication gastroparesis in patients who improved after botulinum toxin injection. J Laparoendosc Adv Surg Tech A. 2017;27(11):1180–4.

    Article  PubMed  Google Scholar 

  • Giron MS, Wang HX, Bernsten C, et al. The appropriateness of drug use in an older non-demented and demented population. J Am Geriatr Soc. 2001;49:277–83.

    Article  CAS  PubMed  Google Scholar 

  • Goetze O, Nikodem AB, Weizcorek J, et al. Predictors of gastric emptying in Parkinson’s disease. Neurogastroenterol Motil. 2006;18:369–75.

    Article  CAS  PubMed  Google Scholar 

  • Halvorsen L, Dotevall G, Walan A. Gastric emptying in patients with achlorhydia or hyposecretion of hydrochloric acid. Scand J Gastroenterol. 1973;8(5):395–9.

    Article  CAS  PubMed  Google Scholar 

  • Hasler WL. Gastroparesis: symptoms, evaluation and treatment. Gastroenterol Clin N Am. 2007;36(3):619–47.

    Article  Google Scholar 

  • Hasler WL, Soudah HC, Dulai G, et al. Mediation of hyperglycemia-evoked gastric slow-wave dysrhythmias by endogenous prostaglandins. Gastroenterology. 1995;108(3):727–36.

    Article  CAS  PubMed  Google Scholar 

  • Heckert J, Sankineni A, Hughes WB, et al. Gastric electric stimulation for refractory gastroparesis: a prospective analysis of 151 patients at a single center. Dig Dis Sci. 2016;61(1):168–75.

    Article  PubMed  Google Scholar 

  • Hejazi RA, Zhang D, McCallum RW. Gastroparesis, pseudoachalasia and impaired intestinal motility as paraneoplastic manifestations of small cell lung cancer. Am J Med Sci. 2009;338(1):69–71.

    Article  PubMed  Google Scholar 

  • Hinder RA, Kelly K. Human gastric pacesetter potential. Site of origin, spread, and response to gastric transection and proximal gastric vagotomy. Am J Surg. 1977;133:29–33.

    Article  CAS  PubMed  Google Scholar 

  • Hirst GD, Edwards FR. Role of interstitial cells of Cajal in the control of gastric motility. J Pharmacol Sci. 2004;96:1–10.

    Article  CAS  PubMed  Google Scholar 

  • Horowitz M, Maddern GJ, Chatterton BE, et al. Changes in gastric emptying rates with age. Clin Sci (Lond). 1984;67(2):213–8.

    Article  CAS  Google Scholar 

  • Hunt JN, Pathk JD. The osmotic effects of some simple molecules and ions on gastric emptying. J Physiol. 1960;154:254–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Jehangir A, Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol. 2017;23(40):7310–20.

    Article  PubMed  PubMed Central  Google Scholar 

  • Jung HK, Choung RS, Locke GR III, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225–33.

    Article  PubMed  Google Scholar 

  • Krishna AY, report BLSJC. reversible gastroparesis inn patients with hypopituitary disease. Am J Med Sci. 1996;312(1):43–5.

    Article  CAS  PubMed  Google Scholar 

  • Kuo P, Rayner CK, Horowitz M. Gastric emptying, diabetes and aging. Clin Geriatr Med. 2007;23:785–808.

    Article  PubMed  Google Scholar 

  • Kupfer RM, Heppell M, Haggith JW, et al. Gastric emptying and small-bowel transit rate in the elderly. J Am Geriatr Soc. 1985;33(5):340–3.

    Article  CAS  PubMed  Google Scholar 

  • Lee AA, Rao S, Nguyen LA, et al. Validation of diagnostic and performance characteristics of the wireless motility capsule in patients with suspected gastroparesis. Clin Gastroenterol Hepatol. 2018. pii: S1543-3565(18)31381-8.

    Google Scholar 

  • Lindeman RD. Overview: renal physiology and pathophysiology of aging. Am J Kidney Dis. 1990;16:275–82.

    Article  CAS  PubMed  Google Scholar 

  • Linnebjerg H, Park S, Kothare PA, et al. Effect of exenatide on gastric emptying and relationship to postprandial glycemia in type 2 diabetes. Regul Pept. 2008;151:123.

    Article  CAS  PubMed  Google Scholar 

  • Lucchinetti CF, Kimmel DW, Lennon VA. Paraneoplastic and oncologic profiles of patients seropositive for type 1 antineuronal nuclear autoantibodies. Neurology. 1998;50:652–7.

    Article  CAS  PubMed  Google Scholar 

  • Madsen JL, Graff J. Effects of ageing on gastrointestinal motor function. Age Ageing. 2004;33(2):154–9.

    Article  PubMed  Google Scholar 

  • Maranki JL, Lytes V, Meilahn JE, et al. Predictive factors for clinical improvement with Enterra gastric electric stimulation treatment for refractory gastroparesis. Dig Dis Sci. 2008;53(8):2072–8.

    Article  PubMed  Google Scholar 

  • Mauer AH, Krevsky B, Knight LC, et al. Opioid and opioid like drug effects on whole-gut transit measured by scintigraphy. J Nucl Med. 1996;37(5):818–22.

    Google Scholar 

  • McCallum RW. Motor function of stomach in health and disease. In: Sleisenger MH, Fordtran JS, editors. Gastrointestinal disease: pathophysiololgy, diagnosis, management, vol. 1. 4th ed. Philadephia: Saunders; 1989. p. 675–713.

    Google Scholar 

  • McCallum RW, Ricci DA, Rakatansky H, et al. A multicenter placebo controlled clinical trial of oral metoclopramide in diabetic gastroparesis. Diabetes Care. 1983;6:463–7.

    Article  CAS  PubMed  Google Scholar 

  • McCallum RW, Chen JD, Lin Z, et al. Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology. 1998;114:456–61.

    Article  CAS  PubMed  Google Scholar 

  • McCallum RW, Lin Z, Forster J, et al. Gastric electrical stimulation improves outcomes in patients with gastroparesis for up to 10 years. Clin Gastroenterol Hepatol. 2011;9:314–9.

    Article  PubMed  Google Scholar 

  • Menke DM, Kyle RA, Fleming CR, et al. Symptomatic gastric amyloidosis in patients with primary systemic amyloidosis. Mayo Clin Proc. 1993;68:763–7.

    Article  CAS  PubMed  Google Scholar 

  • Meyer JH, Ohashi H, Jehn D, Thomson JB. Size of liver particles emptied from the human stomach. Gastroenterology. 1981;80:1489–96.

    Article  CAS  PubMed  Google Scholar 

  • Minami H, McCallum RW. The physiology and pathophysiology of gastric emptying in humans. Gastroenterology. 1984;86(6):1592–610.

    Article  CAS  PubMed  Google Scholar 

  • Mizumoto A, Monchiki E, Suzuki H, Tanaka T, Itoh Z. Neuronal control of motility changes in the canine lower esophageal sphincter and stomach in response to meal ingestion. J Smooth Muscle Res. 1997;33:211–22.

    Article  CAS  PubMed  Google Scholar 

  • Morgan KG, Szurszewski JH. Mechanisms of phasic and tonic actions of pentagastrin on canine gastric smooth muscle. J Physiol. 1980;30:229–42.

    Article  Google Scholar 

  • Myint AS, Rieders B, Tashkandi M, et al. Current and emerging therapeutic options for gastroparesis. Gastroenterol Hepatol (N Y). 2018;14(11):639–45.

    Google Scholar 

  • O’Mahony D, O’Leary P, Quigley EMM. Aging and intestinal motirily a review of factors that affect intestinal motility in the aged. Drugs Aging. 2002;19(7):515–27.

    PubMed  Google Scholar 

  • Park MI, Camilleri M. Gastroparesis: clinical update. Am J Gastroenterol. 2006;101:1129–39.

    Article  PubMed  Google Scholar 

  • Parkman HP, Hasler WL, Fisher RS. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–622.

    Article  PubMed  Google Scholar 

  • Parkman HP, Camilleri M, Farrugia G, et al. Gastroparesis and functional dyspepsia: excerpts from the AGA/ANMS meeting. Neurogastroenterol Motil. 2010;22:113–33.

    Article  CAS  PubMed  Google Scholar 

  • Parrish CR. Nutrition concerns for the patient with gastroparesis. Curr Gastroenterol Rep. 2007;9:295–302.

    Article  PubMed  Google Scholar 

  • Pasricha PJ, Pehlivanov A, Sugumar A, et al. Drug insight: from disturbed motility to disordered movement – a review of the clinical benefits and medicolegal risks of metoclopramide. Nat Clin Pract Gastroenterol Hepatol. 2006;3:138–48.

    Article  CAS  PubMed  Google Scholar 

  • Patterson D, Abell T, Rothstein R, et al. A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis. Am J Gastroenterol. 1999;94:1230–4.

    CAS  PubMed  Google Scholar 

  • Quigley EMM. Gastric motility and sensation in health and disease. In: Feldman M, Friedman L, Sleisenger M, editors. Sleisenger and Fortran’s gastrointestinal and liver disease. 14th ed. New York: Mosby; 2002.

    Google Scholar 

  • Rayner CK, MacIntosh CG, Chapman IM, et al. Effects of age on proximal gastric motor and sensory function. Scand J Gastroenterol. 2000;35(10):1041–7.

    Article  CAS  PubMed  Google Scholar 

  • Reddymasu SC, McCallum RW. Pharmacotherapy of gastroparesis. Expert Opin Pharmacother. 2009;10(3):469–84.

    Article  CAS  PubMed  Google Scholar 

  • Reddymasu SC, McCallum RW. Small intestinal bacterial overgrowth in gastroparesis: are there any predictors? J Clin Gastroenterol. 2010;44:e8–13.

    Article  PubMed  Google Scholar 

  • Sanders MK. Bezoars: from mystical charms to medical and nutritional management. Pract Gastroenterol. 2004;XXVIII:37.

    Google Scholar 

  • Shahid S, Ramzan Z, Maurer AH, et al. Chronic idiopathic constipation: more than a simple colonic transit disorder. J Clin Gastroenterol. 2012;46(2):150–4.

    Article  PubMed  Google Scholar 

  • Smith BD, Smith GL, Hurria A, et al. Future of cancer incidence in the United States: burdens upon an aging, changing nation. J Clin Oncol. 2009;27:2758–65.

    Article  PubMed  Google Scholar 

  • 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;43:2398–404.

    Article  CAS  PubMed  Google Scholar 

  • Syed AA, Rattansingh A, Furtado SD. Current perspectives on management of gastroparesis. J Postgrad Med. 2005;51:54–60.

    CAS  PubMed  Google Scholar 

  • Talley NJ, Locke GR III, Lahr BD, et al. Functional dyspepsia, delayed gastric emptying, and impaired quality of life. Gut. 2006;55:933–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • 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;95:1496–62.

    Article  Google Scholar 

  • Van der Voort IR, Becker JC, Dietl KH, et al. Gastric electrical stimulation results in improved metabolic control in diabetic patients suffering from gastroparesis. Exp Clin Endocrinol Diabetes. 2005;113(1):38–42.

    Article  PubMed  CAS  Google Scholar 

  • Veevers AE, Oxberry SG. Ranitidine: forgotten drug of delayed gastric emptying. BMJ Support Palliat Care. 2017;7(3):255–7.

    PubMed  Google Scholar 

  • Wang YR, Fisher RS, Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol. 2007;103:313–22.

    Article  CAS  PubMed  Google Scholar 

  • Weston S, Thumshirn M, Wiste J, Camilleri M. Clinical and upper gastrointestinal motility features in systemic sclerosis and related disorders. Am J Gastroenterol. 1998;93:1085.

    Article  CAS  PubMed  Google Scholar 

  • Whitson BA, Kandaswamy R, Sutherland DER. Diabetic gastroparesis associated bezoar resolution via cola-lysis. Clin Transpl. 2008;22:242–4.

    Article  Google Scholar 

  • Zikos TA, Kamal AN, Neshatian L, et al. High prevalence of slow transit constipation in patients with gastroparesis. Neurogastroenterol Motil. 2019;25(2):267–75.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Internal Medicine, Texas Tech University Health Science Center, El Paso, TX, USA

    Richard W. McCallum, Marco A. Bustamante Bernal & Luis O. Chavez

  2. Department of Internal Medicine, Division of Gastroenterology, Texas Tech University Health Science Center, El Paso, TX, USA

    Richard W. McCallum & Marco A. Bustamante Bernal

  3. Department of Gastroenterology and Hepatology, Seton Hall University of Health and Medical Sciences, Paterson, NJ, USA

    Ashish Malhotra

Authors
  1. Richard W. McCallum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ashish Malhotra
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Marco A. Bustamante Bernal
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Luis O. Chavez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Richard W. McCallum .

Editor information

Editors and Affiliations

  1. Department of Medicine, Robert Wood Johnson School of Medicine, Rutgers University, New Brunswick, NJ, USA

    C. S. Pitchumoni

  2. Department of Medicine, Division of Geriatrics, Montefiore Medical Center, Wakefield Campus, Bronx, NY, USA

    T.S. Dharmarajan

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this entry

Check for updates. Verify currency and authenticity via CrossMark

Cite this entry

McCallum, R.W., Malhotra, A., Bustamante Bernal, M.A., Chavez, L.O. (2021). Gastroparesis in Older Adults. In: Pitchumoni, C.S., Dharmarajan, T. (eds) Geriatric Gastroenterology. Springer, Cham. https://doi.org/10.1007/978-3-030-30192-7_41

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-30192-7_41

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-30191-0

  • Online ISBN: 978-3-030-30192-7

  • eBook Packages: MedicineReference Module Medicine

Publish with us

Policies and ethics

Search

Navigation