Gastroparesis

Gastroparesis (gastro- from Ancient Greek γαστήρ – gaster, "stomach"; and -paresis, πάρεσις – "partial paralysis") is a medical disorder of ineffective neuromuscular contractions (peristalsis) of the stomach, resulting in food and liquid remaining in the stomach for a prolonged period. Stomach contents thus exit more slowly into the duodenum of the digestive tract, a medical sign called delayed gastric emptying. The opposite of this, where stomach contents exit quickly into the duodenum, is called dumping syndrome. Symptoms include nausea, vomiting, abdominal pain, feeling full soon after beginning to eat (early satiety), abdominal bloating, and heartburn. Many or most cases are idiopathic. The most commonly known cause is autonomic neuropathy of the vagus nerve, which innervates the stomach. Uncontrolled diabetes mellitus is a frequent cause of this nerve damage, but trauma to the vagus nerve is also possible. Some cases may be considered post-infectious. Diagnosis is via one or more of the following: barium swallow X-ray, barium beefsteak meal, radioisotope gastric-emptying scan, gastric manometry, esophagogastroduodenoscopy (EGD), and a stable isotope breath test. Complications include malnutrition, fatigue, weight loss, vitamin deficiencies, intestinal obstruction due to bezoars, and small intestinal bacterial overgrowth. There may also be poor glycemic control and irregular absorption of nutrients, particularly in the setting of diabetes. Treatment includes dietary modification, medications to stimulate gastric emptying (including some prokinetic agents), medications to reduce vomiting (including some antiemetics), and surgical approaches. Additionally, gastric electrical stimulation (GES; approved on a humanitarian device exemption) can be used as treatment. Nutrition may be managed variously, ranging from oral dietary modification to jejunostomy feeding tube (if oral intake is inadequate). A gastroparesis diagnosis is associated with poor outcomes, and survival is generally lower among patients than in the general population.