Central PA Medicine - Summer 2017 - 26

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Community, Health & Wellness

Gastroparesis can be frustrating for
patients and physicians because the source
of the poor gastric emptying is often
unknown. In idiopathic gastroparesis, no
detectable primary underlying abnormality
is found. Diabetes mellitus is the most
common disease associated with gastroparesis. Diabetic gastroparesis typically
occurs in patients who have had diabetes
5 or more years. It tends to be worse in
Type I diabetics and in any diabetic blood
sugar is not adequately controlled.
Previous gastric and thoracic surgery
can result in poor gastric emptying due to
intended or accidental injury of the nerves
to the stomach. Fundoplication, a surgery
for acid reflux, is one common surgery
which can result in this type of nerve injury.

TREATMENT OF
GASTROPARESIS

includes dietary modification,
hydration, glycemic control and medication.

Treatment of gastroparesis includes dietary
modification, hydration, glycemic control
and medication. Dietary modification is firstline therapy. Foods with nondigestible fiber
(fruits and vegetables) empty the stomach
There are reports of gastroparesis occurring very poorly and should be eliminated from
suddenly after a viral infection. Post-viral the diet. Fat slows gastric emptying and
gastroparesis usually is self-limited and should be reduced. As important, patients
will improve within a year, but not always. with gastropesis are advised to consume
Medications such as narcotics and anti- small, frequent meals four to five times a
depressants, to name a few, can produce day. Eating large meals exponentially worsens
gastroparesis. Other sources of gastroparesis symptoms. Frequent nausea and vomiting
include thyroid disease, multiple sclerosis, leads to dehydration and vitamin deficiencies.
Parkinson's disease, and scleroderma.
Hydration and vitamin supplementation
should be provided to all patients. In patients
When evaluating these patients, it is im- with diabetes, proper control of blood sugar
perative to make sure they have no physical is important not only for their diabetes but
obstruction of the stomach. Obstruction also to reduce the long term worsening of
can be caused by large gastric or duodenal their gastroparesis.
ulcers or gastric cancer. Tests such as upper
endoscopy and upper GI x-ray can help rule
Metoclopramide is first-line therapy for
out mechanical obstruction. In gastroparesis, gastroparetics. Metoclopramide works by
upper endoscopy will reveal a stomach that increasing the contractions of the stomach
will look absolutely normal, but retained to improve gastric emptying. The FDA
food may be encountered.
approved metoclopramide for treatment of
gastroparesis for no longer than 12 weeks
Once mechanical obstruction is ruled unless patients have a therapeutic benefit
out, assessment of gastric motion is the that outweighs the risk. This medication
next step. This is typically done with a has significant side effects and should
gastric emptying study. The patient ingests be used cautiously. Domperidone is a
a low fat, scrambled egg meal and gastric medication that can be used in those who
emptying is monitored over the next 4 fail metoclopramide.
hours. Delayed gastric emptying is defined
as gastric retention of > 10 percent at four
Interestingly, the antibiotic erythromycin
hours and/or > 60 percent at two hours of has been shown to significantly improve
the scrambled egg meal.
gastric emptying in its intravenous form.
Oral erythromycin has been shown to be
26 Summer 2017 Central PA Medicine

much less effective, but nevertheless can be
worth a try if the patient has not responded
to another form of therapy. Of course, classic
anti-nausea medication can also be used to
provide relief.
For those patients that have no improvement with the above, a feeding tube can be
placed into the stomach. This tube actually
relieves the pressure in the stomach and is
not intended to feed the patient. Feeding
can be done with a separate tube placed
downstream into the small bowel, beyond
the slow stomach. In severe cases, feeding
can be accomplished thru an intravenous
line into the patient's vein if they cannot
tolerate any nutrition into the intestine.
Surgery is almost never needed in patients
with gastroparesis.
Finally, gastric electrical stimulation can
be accomplished in patients with refractory
symptoms. Otherwise known as the gastric
pacemaker, this device increases the motility
of the stomach to improve gastric emptying.
Gastroparesis can be a difficult and
frustrating disease for patients due its
waxing and waning pattern and lack of
identifiable cause. Diabetes is the most
common known cause of gastroparesis and
we can expect much more gastroparesis in
the future due to the rising rates of diabetes
in the United States.


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