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[IP] New article on gastroparesis

 A new article today from Curr Treat Options Gastroenterol. 2006
Jul;9(4):295-304. I thought it might be of interest since some have been
discussing gastroparesis and its treatments.


Delayed gastric emptying: whom to test, how to test, and what to do.

Friedenberg FK, Parkman HP.

 Temple University School of Medicine, Gastroenterology Section, Parkinson
Pavilion, 8th Floor, 3401 North Broad Street, Philadelphia, PA 19140, USA.
henry.parkman@ temple.edu.

 Gastroparesis, or delayed gastric emptying, is a common cause of chronic nausea
and vomiting as seen in a gastroenterology practice. Diabetic, postsurgical, and
idiopathic causes remain the three most common forms of gastroparesis. In
addition to nausea and vomiting, symptoms of gastroparesis may include early
satiety, postprandial fullness, and abdominal pain. Physiologic changes that may
explain symptoms in patients with gastroparesis, in addition to delayed gastric
emptying, include impaired fundic accommodation, antral hypomotility, gastric
dysrhythmias, pylorospasm, and perhaps visceral hypersensitivity. Diagnosis of
gastroparesis is best determined using a radioisotope-labeled solid meal with
scintigraphic imaging for at least 2 hours, and preferably 4 hours,
postprandially. Most commonly, a 99mTc sulfur colloid-labeled egg sandwich with
imaging at 0, 1, 2, and 4 hours is used. Extension of the gastric emptying test
to 4 hours improves the accuracy of the test, but unfortunately, this is not
commonly performed at many centers. Emptying of liquids remains normal until the
late stages of gastroparesis and is less useful. The aims of treatment should be
to control symptoms and maintain adequate nutrition and hydration. Patients
should be advised to eat small meals and to limit their intake of fat and fiber.
Additional dietary recommendations may include increasing caloric intake in the
form of liquids. For diabetic patients, control of blood glucose levels is
important, as symptom exacerbation is frequently associated with poor glycemic
control. Specific treatment often begins with metoclopramide, 10 mg, up to four
times daily, after a discussion of possible side effects with the patient. An
antiemetic agent, such as prochlorperazine, 5 to 10 mg orally or 25 mg by
suppository, can be added on an as-needed basis every 4 to 6 hours to control
nausea. If these antiemetic medications are not effective, or if side effects
develop, orally dissolving ondansetron, 8 mg every 8 to 12 hours, can be tried
on an as-needed
 ative prokinetic agents--erythromycin, 125 mg, or tegaserod, 6 mg, prior to
meals--can be tried. For cases refractory to these treatments, referral to a
center with US Food and Drug Administration permission to use domperidone should
be considered. Alternatively, symptom modulators such as low-dose tricyclic
antidepressants can be tried to reduce symptoms, but these do not improve
gastric emptying. In patients for whom all medical therapy fails, other options
that are tried at experienced centers include the injection of botulinum toxin
into the pylorus, placement of a feeding jejunostomy, and/or placement of a
gastric electrical stimulator.

PMID: 16836948 [PubMed - in process]
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