Gastroparesis (gastro- from Ancient Greek – gaster, "stomach"; and -paresis, πάρεσις – "partial paralysis") is a medical disorder of ineffective neuromuscular contractions (
peristalsis
Peristalsis ( , ) is a type of intestinal motility, characterized by symmetry in biology#Radial symmetry, radially symmetrical contraction and relaxation of muscles that propagate in a wave down a tube, in an wikt:anterograde, anterograde dir ...
) of the
stomach
The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...
, resulting in food and liquid remaining in the stomach for a prolonged period. Stomach contents thus exit more slowly into the
duodenum
The duodenum is the first section of the small intestine in most vertebrates, including mammals, reptiles, and birds. In mammals, it may be the principal site for iron absorption.
The duodenum precedes the jejunum and ileum and is the shortest p ...
of the
digestive tract
The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the Digestion, digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascula ...
, 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
Satiety ( /səˈtaɪ.ə.ti/ ''sə-TYE-ə-tee'') is a state or condition of fullness gratified beyond the point of satisfaction, the opposite of hunger. Following satiation (meal termination), satiety is a feeling of fullness lasting until the next ...
), abdominal bloating, and heartburn. Many or most cases are
idiopathic
An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin.
For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause ...
. The most commonly known cause is
autonomic neuropathy
Autonomic neuropathy (AN or AAN) is a form of polyneuropathy that affects the non-voluntary, non-sensory nervous system (i.e., the autonomic nervous system), affecting mostly the internal organs such as the bladder muscles, the cardiovascular syst ...
of the
vagus nerve
The vagus nerve, also known as the tenth cranial nerve (CN X), plays a crucial role in the autonomic nervous system, which is responsible for regulating involuntary functions within the human body. This nerve carries both sensory and motor fibe ...
, which innervates the stomach. Uncontrolled
diabetes mellitus
Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained hyperglycemia, high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or th ...
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
An upper gastrointestinal series, also called a barium swallow, barium study, or barium meal, is a series of radiographs used to examine the gastrointestinal tract for abnormalities. A contrast medium, usually a radiocontrast agent such as bariu ...
X-ray, barium beefsteak meal,
radioisotope
A radionuclide (radioactive nuclide, radioisotope or radioactive isotope) is a nuclide that has excess numbers of either neutrons or protons, giving it excess nuclear energy, and making it unstable. This excess energy can be used in one of three ...
gastric-emptying scan, gastric
manometry,
esophagogastroduodenoscopy
Esophagogastroduodenoscopy (EGD) or oesophagogastroduodenoscopy (OGD), also called by various other names, is a diagnostic endoscopic procedure that visualizes the upper part of the gastrointestinal tract down to the duodenum. It is considered ...
(EGD), and a
stable isotope breath test. Complications include
malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a deficiency, excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues a ...
, fatigue,
weight loss
Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other conn ...
, vitamin deficiencies,
intestinal obstruction
Bowel obstruction, also known as intestinal obstruction, is a mechanical or functional obstruction of the intestines which prevents the normal movement of the products of digestion. Either the small bowel or large bowel may be affected. Signs ...
due to
bezoar
A bezoar stone ( ) is a mass often found trapped in the gastrointestinal system, though it can occur in other locations. A pseudobezoar is an indigestible object introduced intentionally into the digestive system.
There are several varieties o ...
s, and
small intestinal bacterial overgrowth
Small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowth, or small bowel bacterial overgrowth syndrome (SBBOS), is a disorder of excessive bacterial growth in the small intestine. Unlike the colon (or large bowel), which is r ...
. 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
antiemetic
An antiemetic is a drug that is effective against vomiting and nausea. Antiemetics are typically used to treat motion sickness and the side effects of opioid analgesics, general anaesthetics, and chemotherapy directed against cancer. They may ...
s), 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.
Signs and symptoms
Gastroparesis has been linked to vomiting
Vomiting (also known as emesis, puking and throwing up) is the forceful expulsion of the contents of one's stomach through the mouth and sometimes the nose.
Vomiting can be the result of ailments like food poisoning, gastroenteritis, pre ...
, bloating
Abdominal bloating (or simply bloating) is a short-term disease that affects the gastrointestinal tract. Bloating is generally characterized by an excess buildup of gas, air or fluids in the stomach. A person may have feelings of tightness, pressu ...
, early satiety
Satiety ( /səˈtaɪ.ə.ti/ ''sə-TYE-ə-tee'') is a state or condition of fullness gratified beyond the point of satisfaction, the opposite of hunger. Following satiation (meal termination), satiety is a feeling of fullness lasting until the next ...
, and epigastric pain. Symptoms of delayed gastric emptying tend to be exacerbated by eating, particularly after fatty foods and indigestible solids like salads and leafy vegetables. In general, nausea
Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. It can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the throat.
Over 30 d ...
is the most commonly reported symptom, affecting up to 96% of gastroparesis patients. However, depending on the etiology, the predominant symptom reported can differ. The severity of gastric emptying dysfunction does not correspond to the severity of symptoms. Heartburn
Heartburn is a burning sensation felt behind the breastbone. It is a symptom that is commonly linked to acid reflux and is often triggered by food, particularly fatty, sugary, spicy, chocolate, citrus, onion-based and tomato-based products. Ly ...
and poor glycemic control may be the only symptoms of delayed gastric emptying in diabetic
Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
patients. Physical examination in patients with gastroparesis may be completely normal or, in its more severe forms, dehydration
In physiology, dehydration is a lack of total body water that disrupts metabolic processes. It occurs when free water loss exceeds intake, often resulting from excessive sweating, health conditions, or inadequate consumption of water. Mild deh ...
and malnutrition
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a deficiency, excess, or imbalance of energy, protein and other nutrients which adversely affects the body's tissues a ...
, as well as a succussion splash, can be present.
Nausea in gastroparesis is usually postprandial
Prandial relates to a meal. Postprandial (from post prandium) means after eating a meal, while preprandial is before a meal.
Usages of postprandial
The term ''postprandial'' is used in multiple contexts.
Gastronomic or social
Refers to activiti ...
, but morning or persistent nausea may occur. Vomiting is characterized by retching and forceful evacuation of gastric contents from the stomach
The stomach is a muscular, hollow organ in the upper gastrointestinal tract of Human, humans and many other animals, including several invertebrates. The Ancient Greek name for the stomach is ''gaster'' which is used as ''gastric'' in medical t ...
up to and out of the mouth. Some patients may experience retching without gastric contents being expelled.
Postprandial fullness is an unpleasant feeling of stomach fullness that occurs after eating. Patients might characterize postprandial fullness as a feeling of food remaining in the stomach for an extended period. Satiation is a lack of hunger
In politics, humanitarian aid, and the social sciences, hunger is defined as a condition in which a person does not have the physical or financial capability to eat sufficient food to meet basic nutritional needs for a sustained period. In t ...
after eating. It is the inverse of hunger and appetite
Appetite is the desire to eat food items, usually due to hunger. Appealing foods can stimulate appetite even when hunger is absent, although appetite can be greatly reduced by satiety. Appetite exists in all higher life-forms, and serves to reg ...
. Early satiety is the disappearance of appetite before nutrient absorption during food ingestion. People with gastroparesis may describe early satiation as a loss of appetite
Anorexia is a medical term for a loss of appetite. While the term outside of the scientific literature is often used interchangeably with anorexia nervosa, many possible causes exist for a loss of appetite, some of which may be harmless, while o ...
or disappearance of appetite while eating. Early satiety is the sensation of stomach fullness that occurs shortly after beginning to eat and is out of proportion to the meal.
Bloating is a highly subjective feeling of increased abdominal pressure. Bloating without eating should be distinguished from postprandial fullness. It is sometimes, but not always, associated with food consumption.
Abdominal discomfort or pain is common, affecting 90% of gastroparesis patients. Idiopathic gastroparesis patients may experience more abdominal pain
Abdominal pain, also known as a stomach ache, is a symptom associated with both non-serious and serious medical issues. Since the abdomen contains most of the body's vital organs, it can be an indicator of a wide variety of diseases. Given th ...
than diabetic gastroparesis patients. Physicians believe that postprandial epigastric pain is the most common symptom of gastroparesis. Abdominal pain has a wide range of symptoms. Around 40% of patients have localized epigastric pain, but it can be diffuse in some cases. Pain is usually classified as postprandial, but it can also occur at night and interfere with sleep. The severity of abdominal pain is unrelated to the impairment of gastric emptying.
Complications
Gastroparesis can lead to difficult glycemic control (which exacerbates gastric dysmotility), aspiration, bezoar
A bezoar stone ( ) is a mass often found trapped in the gastrointestinal system, though it can occur in other locations. A pseudobezoar is an indigestible object introduced intentionally into the digestive system.
There are several varieties o ...
formation, abnormalities in fluid and electrolyte
An electrolyte is a substance that conducts electricity through the movement of ions, but not through the movement of electrons. This includes most soluble Salt (chemistry), salts, acids, and Base (chemistry), bases, dissolved in a polar solven ...
balance, and inadequate nutrition intake resulting in weight loss
Weight loss, in the context of medicine, health, or physical fitness, refers to a reduction of the total body mass, by a mean loss of fluid, body fat (adipose tissue), or lean mass (namely bone mineral deposits, muscle, tendon, and other conn ...
.
Some patients may experience severe nausea and vomiting, which can lead to dehydration
In physiology, dehydration is a lack of total body water that disrupts metabolic processes. It occurs when free water loss exceeds intake, often resulting from excessive sweating, health conditions, or inadequate consumption of water. Mild deh ...
, as evidenced by orthostatic hypotension
Orthostatic hypotension, also known as postural hypotension, is a medical condition wherein a person's blood pressure drops when they are standing up ( orthostasis) or sitting down. Primary orthostatic hypotension is also often referred to as ne ...
as well as acute renal insufficiency. Some patients with severe gastroparesis lose a significant amount of weight and suffer from nutritional deficiencies
Malnutrition occurs when an organism gets too few or too many nutrients, resulting in health problems. Specifically, it is a Deficiency (medicine), deficiency, excess, or imbalance of energy, protein and Vitamin deficiency, other nutrients whic ...
, necessitating small bowel
The small intestine or small bowel is an organ in the gastrointestinal tract where most of the absorption of nutrients from food takes place. It lies between the stomach and large intestine, and receives bile and pancreatic juice through the p ...
feeding access to bypass the stomach.
Individuals with gastroparesis are also more likely to develop gastric bezoars. Bezoars are large masses of foreign substances and food trapped in the GI tract
The gastrointestinal tract (GI tract, digestive tract, alimentary canal) is the tract or passageway of the digestive system that leads from the mouth to the anus. The tract is the largest of the body's systems, after the cardiovascular system. T ...
, especially in the stomach. The incidence of bezoar formation in gastroparesis patients has been estimated to be approximately six percent based on a barium study.
There is a strong link between gastroparesis and the development of small intestinal bacterial overgrowth
Small intestinal bacterial overgrowth (SIBO), also termed bacterial overgrowth, or small bowel bacterial overgrowth syndrome (SBBOS), is a disorder of excessive bacterial growth in the small intestine. Unlike the colon (or large bowel), which is r ...
(SIBO). One study examined 50 gastroparesis patients using a glucose breath test and discovered that SIBO was present in 60% of their cohort. Furthermore, longer episodes of gastroparesis symptoms increase the risk of SIBO. Poor gastrointestinal motility (see enteric nervous system
The enteric nervous system (ENS) is one of the three divisions of the autonomic nervous system (ANS), the others being the sympathetic nervous system (SNS) and parasympathetic nervous system (PSNS). It consists of a mesh-like system of neurons th ...
) and gastric acid
Gastric acid or stomach acid is the acidic component – hydrochloric acid – of gastric juice, produced by parietal cells in the gastric glands of the stomach lining. In humans, the pH is between one and three, much lower than most other a ...
production are believed to allow bacteria
Bacteria (; : bacterium) are ubiquitous, mostly free-living organisms often consisting of one Cell (biology), biological cell. They constitute a large domain (biology), domain of Prokaryote, prokaryotic microorganisms. Typically a few micr ...
to colonize the small intestine
The small intestine or small bowel is an organ (anatomy), organ in the human gastrointestinal tract, gastrointestinal tract where most of the #Absorption, absorption of nutrients from food takes place. It lies between the stomach and large intes ...
. Furthermore, many individuals with gastroparesis are treated with acid-suppressive drugs, which significantly impair the GI tract's innate bactericidal activity. SIBO causes small bowel inflammation, impairing absorption and worsening nutritional deficiencies in gastroparesis.
Because of the debilitating symptoms, patients with gastroparesis are at risk of significant nutritional abnormalities. In one study, 305 patients with gastroparesis had their dietary intake and nutritional status evaluated, and the average caloric intake was 1168 kcal/day, which resulted in substantial nutritional deficiencies. Furthermore, 64% of gastroparesis patients consumed a calorie-deficient diet. Additionally, higher symptom scores were inversely proportional to caloric intake. Another study found that the severity of nutritional deficiencies was proportional to the duration of gastric emptying. Minerals like iron
Iron is a chemical element; it has symbol Fe () and atomic number 26. It is a metal that belongs to the first transition series and group 8 of the periodic table. It is, by mass, the most common element on Earth, forming much of Earth's o ...
, fat-soluble vitamins, thiamine
Thiamine, also known as thiamin and vitamin B1, is a vitamin – an Nutrient#Micronutrients, essential micronutrient for humans and animals. It is found in food and commercially synthesized to be a dietary supplement or medication. Phosp ...
, and folate
Folate, also known as vitamin B9 and folacin, is one of the B vitamins. Manufactured folic acid, which is converted into folate by the body, is used as a dietary supplement and in food fortification as it is more stable during processing and ...
are commonly reported deficiencies. Iron deficiency
Iron deficiency, or sideropenia, is the state in which a body lacks enough iron to supply its needs. Iron is present in all cells in the human body and has several vital functions, such as carrying oxygen to the tissues from the lungs as a key ...
is common in patients with gastroparesis.
Other complications include fluctuations in blood glucose
The blood sugar level, blood sugar concentration, blood glucose level, or glycemia is the measure of glucose concentrated in the blood. The body tightly blood sugar regulation, regulates blood glucose levels as a part of metabolic homeostasis ...
due to unpredictable digestion times due to changes in rate and amount of food passing into the small bowel, a decrease in quality of life
Quality of life (QOL) is defined by the World Health Organization as "an individual's perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards ...
, since it can make keeping up with work and other responsibilities more difficult, and severe fatigue
Fatigue is a state of tiredness (which is not sleepiness), exhaustion or loss of energy. It is a signs and symptoms, symptom of any of various diseases; it is not a disease in itself.
Fatigue (in the medical sense) is sometimes associated wit ...
due to caloric deficit.
Causes
There are many possible etiologies of gastroparesis. Many cases are idiopathic, and others are secondary to chronic or systemic conditions. Gastroparesis may also be acquired after an infection or trauma, or it may be iatrogenic.
People with gastroparesis are disproportionately female. One possible explanation for this finding is that women have an inherently slower stomach emptying time than men. A hormonal link has been suggested, as gastroparesis symptoms tend to worsen the week before menstruation when progesterone levels are highest.
Idiopathic
Idiopathic gastroparesis (gastroparesis with no known cause) accounts for a third (or more) of all chronic cases. It is thought that many of these cases are due to an autoimmune response, perhaps triggered by an acute viral infection. Gastroenteritis
Gastroenteritis, also known as infectious diarrhea, is an inflammation of the Human gastrointestinal tract, gastrointestinal tract including the stomach and intestine. Symptoms may include diarrhea, vomiting, and abdominal pain. Fever, lack of ...
, infectious mononucleosis
Infectious mononucleosis (IM, mono), also known as glandular fever, is an infection usually caused by the Epstein–Barr virus (EBV). Most people are infected by the virus as children, when the disease produces few or no symptoms. In young adu ...
, and other ailments have been anecdotally linked to the onset of the condition, but no systematic study has proven a link. In cases of post-infectious gastroparesis, patients have symptoms and go undiagnosed for an average of 3 weeks to 6 months before their illness is identified correctly and treatment begins.
Chronic conditions
It is frequently caused by autonomic neuropathy
Autonomic neuropathy (AN or AAN) is a form of polyneuropathy that affects the non-voluntary, non-sensory nervous system (i.e., the autonomic nervous system), affecting mostly the internal organs such as the bladder muscles, the cardiovascular syst ...
, occurring in about 30–50% of people with long-standing type 1 or type 2 diabetes
Type 2 diabetes (T2D), formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent ...
. In fact, diabetes mellitus has been named as the most common known cause of gastroparesis, as high levels of blood glucose may effect chemical changes in the nerves. The vagus nerve becomes damaged by years of high blood glucose or insufficient glucose transport into cells, resulting in gastroparesis. Adrenal and thyroid gland problems could also be a cause.
Gastroparesis can be seen in connective tissue disease such as scleroderma
Scleroderma is a group of autoimmune diseases that may result in changes to the skin, blood vessels, muscles, and internal organs. The disease can be either localized to the skin or involve other organs, as well. Symptoms may include areas ...
and neurological conditions such as Parkinson's disease
Parkinson's disease (PD), or simply Parkinson's, is a neurodegenerative disease primarily of the central nervous system, affecting both motor system, motor and non-motor systems. Symptoms typically develop gradually and non-motor issues become ...
and multiple system atrophy
Multiple system atrophy (MSA) is a rare neurodegenerative disorder characterized by tremors, slow movement, muscle rigidity, postural instability (collectively known as parkinsonism), autonomic dysfunction and ataxia. This is caused by progr ...
. It may occur as part of a mitochondrial disease. Chronic gastroparesis can be caused by other types of damage to the vagus nerve, such as abdominal surgery
The term abdominal surgery broadly covers surgical procedures that involve opening the abdomen (laparotomy). Surgery of each abdominal organ is dealt with separately in connection with the description of that organ (see stomach, kidney, liver, e ...
.
Gastroparesis has been associated with connective tissue disorders such as Marfan syndrome
Marfan syndrome (MFS) is a multi-systemic genetic disorder that affects the connective tissue. Those with the condition tend to be tall and thin, with dolichostenomelia, long arms, legs, Arachnodactyly, fingers, and toes. They also typically ha ...
, Loeys–Dietz syndrome and Ehlers–Danlos syndrome
Ehlers–Danlos syndromes (EDS) is a group of 14 genetic connective-tissue disorders. Symptoms often include loose joints, joint pain, stretchy velvety skin, and abnormal scar formation. These may be noticed at birth or in early childhood. Co ...
. This is due to laxity of the stomach and gastrointestinal tissues.
Other causes
Transient gastroparesis may arise in acute illness of any kind, as a consequence of certain cancer treatments or other drugs which affect digestive action, or due to abnormal eating patterns. Heavy cigarette
A cigarette is a narrow cylinder containing a combustible material, typically tobacco, that is rolled into Rolling paper, thin paper for smoking. The cigarette is ignited at one end, causing it to smolder; the resulting smoke is orally inhale ...
smoking is also a plausible cause since smoking causes damage to the stomach lining.
Patients with cancer may develop gastroparesis because of chemotherapy-induced peripheral neuropathy, immunosuppression followed by viral infections involving the GI tract, procedures such as celiac blocks, paraneoplastic neuropathy or myopathy
In medicine, myopathy is a disease of the muscle in which the muscle fibers do not function properly. ''Myopathy'' means muscle disease ( Greek : myo- ''muscle'' + patheia '' -pathy'' : ''suffering''). This meaning implies that the primary defec ...
, or after an allogeneic bone marrow transplant via graft-versus-host disease
Graft-versus-host disease (GvHD) is a syndrome, characterized by inflammation in different organs. GvHD is commonly associated with bone marrow transplants and stem cell transplants.
White blood cells of the donor's immune system which rema ...
.
An analysis by University Hospitals Cleveland Medical Center of records from the TriNetX database found that the number of patients diagnosed with gastroparesis after being prescribed a GLP-1 receptor agonist (0.1% of the patients) was 250% greater than the number of patients diagnosed with gastroparesis who did not take a GLP-1 medication (0.04%).
Physiology and mechanism
The symptoms of gastroparesis are best understood in the context of the physiology of gastric emptying (GE). The stomach is a reservoir for food and nutritional content, which are broken down to produce chyme. Chyme is then released into the duodenum at a controlled rate, allowing maximum nutrient absorption. The controlled rate of chyme released is regulated by feedback mechanisms from the stomach and small intestines, which activate the vagus nerve and other hormones. The delay of any of the factors in gastric emptying causes disorganization or reduced frequency of antral contractions and thus delayed GE.
On the molecular level, it is thought that gastroparesis can be caused by the loss of neuronal nitric oxide
Nitric oxide (nitrogen oxide, nitrogen monooxide, or nitrogen monoxide) is a colorless gas with the formula . It is one of the principal oxides of nitrogen. Nitric oxide is a free radical: it has an unpaired electron, which is sometimes den ...
expression since the cells in the GI tract secrete nitric oxide. This important signaling molecule has various responsibilities in the GI tract and in muscles throughout the body. When nitric oxide levels are low, the smooth muscle
Smooth muscle is one of the three major types of vertebrate muscle tissue, the others being skeletal and cardiac muscle. It can also be found in invertebrates and is controlled by the autonomic nervous system. It is non- striated, so-called bec ...
and other organs may not be able to function properly. Other important components of the stomach are the interstitial cells of Cajal (ICC), which act as a pacemaker since they transduce signals from motor neuron
A motor neuron (or motoneuron), also known as efferent neuron is a neuron whose cell body is located in the motor cortex, brainstem or the spinal cord, and whose axon (fiber) projects to the spinal cord or outside of the spinal cord to directly o ...
s to produce an electrical rhythm in the smooth muscle cells. Lower nitric oxide levels also correlate with loss of ICC cells, which can ultimately lead to the loss of function in the smooth muscle in the stomach, as well as in other areas of the gastrointestinal tract.
Pathogenesis of symptoms in diabetic gastroparesis includes:
* Loss of gastric neurons containing nitric oxide synthase (NOS) is responsible for defective accommodation reflex, which leads to early satiety
Satiety ( /səˈtaɪ.ə.ti/ ''sə-TYE-ə-tee'') is a state or condition of fullness gratified beyond the point of satisfaction, the opposite of hunger. Following satiation (meal termination), satiety is a feeling of fullness lasting until the next ...
and postprandial fullness.
* Impaired electromechanical activity in the myenteric plexus
The myenteric plexus (or Auerbach's plexus) provides motor innervation to both layers of the muscular layer of the gut, having both parasympathetic and sympathetic input (although present ganglion cell bodies belong to parasympathetic innervatio ...
is responsible for delayed gastric emptying, resulting in nausea and vomiting.
* Sensory neuropathy in the gastric wall may be responsible for epigastric pain.
* Abnormal pacemaker activity (tachybradyarrhythmia) may generate a noxious signal transmitted to the CNS to evoke nausea and vomiting.
Diagnosis
Gastroparesis is suspected in patients who have abdominal pain, nausea, vomiting, or bloating, or when these symptoms occur after eating. Once an upper endoscopy has been performed to exclude peptic ulcer disease
Peptic ulcer disease is when the inner part of the stomach's gastric mucosa (lining of the stomach), the first part of the small intestine, or sometimes the lower esophagus, gets damaged. An ulcer in the stomach is called a gastric ulcer, while ...
or gastric outlet obstruction
Gastric outlet obstruction (GOO) is a medical condition where there is an obstruction at the level of the pylorus, which is the outlet of the stomach. Individuals with gastric outlet obstruction will often have recurrent vomiting of food that ha ...
as the root of their symptoms, those patients should be tested for gastroparesis.
Differential diagnosis
More than 30% of patients with severe gastroparesis symptoms also experience severe constipation. This may be linked to delayed small bowel and colon transit. If symptoms are refractory
In materials science, a refractory (or refractory material) is a material that is resistant to decomposition by heat or chemical attack and that retains its strength and rigidity at high temperatures. They are inorganic, non-metallic compound ...
(especially in the setting of weight loss), or if an intestinal neuromyopathic disorder is suspected, then motility may be evaluated via antroduodenal manometry, wireless motility capsules, whole gut scintigraphy, or radiopaque markers. Extragastric dysmotility may also be treated with prokinetic medications.
Testing overview
There are several tests available to diagnose gastroparesis. Gastric emptying scintigraphy (GES) is the current gold standard. Often, it cannot distinguish gastroparesis from functional dyspepsia
Functional dyspepsia (FD) is a common gastrointestinal disorder defined by symptoms arising from the gastroduodenal region in the absence of an underlying organic disease that could easily explain the symptoms. Characteristic symptoms include ep ...
, both of which feature bloating, and both of which may be part of a spectrum of gastric neuromuscular dysfunction. In addition, symptom severity may not correspond to the extent of delayed gastric emptying as measured by scintigraphy.
Alternatives include stable isotope breath tests with carbon-13, which are unreliable in the setting of many diseases; wireless motility capsules, which may permit a more thorough examination; and antroduodenal manometry, which is invasive but may provide some information as to the etiopathogenesis.
Other imaging modalities are rarely used. MRI is expensive. Ultrasound requires expertise and is challenging in the setting of obesity.
Gastric emptying scintigraphy
Griffith et al. first described GES in 1966, and it has since become the gold standard for diagnosing gastroparesis. Following an overnight fast, the patient consumes a standardized, radiotracer-bound, low-fat meal within 10 minutes of this test. A longer ingestion time may alter the results.
Most medical facilities use 99mTc sulfur colloid-labeled egg sandwiches or Egg Beaters egg whites with 1–2 slices of bread, strawberry jam, and water. Previously, studies labeled both the solid and liquid phases of a meal; however, present standard tests just label the solid phase of a meal, since liquid emptying only becomes delayed in the most advanced stages of gastroparesis. However, when assessing for postsurgical anatomic issues or ruling out dumping syndrome in postsurgical patients, testing liquid emptying is valuable.
Following ingestion, the patient undergoes standard imaging of the gastric area while standing, and the percentage of radioactivity left in the stomach is recorded using computerized software and normalized to the baseline value at 1, 2, and 4 hours postprandially. Gastric emptying is considered delayed if there is more than 60% retention at 2 hours and/or more than 10% retention at 4 hours.
Stable isotope breath tests with carbon-13
The stable isotope breath test involves using the stable isotope carbon-13
Carbon-13 (13C) is a natural, stable isotope of carbon with a nucleus containing six protons and seven neutrons. As one of the environmental isotopes, it makes up about 1.1% of all natural carbon on Earth.
Detection by mass spectrometry
A m ...
(13C) in a medium-chain fatty acid
In chemistry, in particular in biochemistry, a fatty acid is a carboxylic acid with an aliphatic chain, which is either saturated and unsaturated compounds#Organic chemistry, saturated or unsaturated. Most naturally occurring fatty acids have an ...
substrate such as octanoic acid. After that, the 13C-labeled substrate is attached to a food that can be digested, like muffins, or to '' Spirulina platensis'', a blue-green algae that is 50–60% protein, 30% starch, and 10% lipids.
Following an overnight fast, pre-meal breath samples are taken, and then meals are consumed. 13C-octanoate is absorbed in the duodenum
The duodenum is the first section of the small intestine in most vertebrates, including mammals, reptiles, and birds. In mammals, it may be the principal site for iron absorption.
The duodenum precedes the jejunum and ileum and is the shortest p ...
and liquefies to chyme
Chyme or chymus (; ) is the semi-fluid mass of partly digested food that is expelled by the stomach, through the pyloric valve, into the duodenum (the beginning of the small intestine).
Chyme results from the mechanical and chemical breakdown ...
after feeding and after the stomach has been emptied. It is then transported to the liver
The liver is a major metabolic organ (anatomy), organ exclusively found in vertebrates, which performs many essential biological Function (biology), functions such as detoxification of the organism, and the Protein biosynthesis, synthesis of var ...
via the portal circulation and metabolized to 13-carbon dioxide (13CO2) before being exhaled during expiration.
Because stomach emptying is the testing process's rate-limiting step, the amount of 13CO2 present in an exhaled breath test represents gastric emptying. Every 30 minutes, post-meal breath samples are collected and analyzed using isotope-ratio mass spectrometry
Isotope-ratio mass spectrometry (IRMS) is a specialization of mass spectrometry, in which mass spectrometric methods are used to measure the relative abundance of isotopes in a given sample.
This technique has two different applications in the e ...
. For a total of 4–6 hours, samples are collected every 30 minutes.
The stable isotope breath test is unreliable for individuals with small bowel diseases like celiac disease
Coeliac disease (British English) or celiac disease (American English) is a long-term autoimmune disorder, primarily affecting the small intestine. Patients develop intolerance to gluten, which is present in foods such as wheat, rye, spel ...
, exocrine pancreatic insufficiency
Exocrine pancreatic insufficiency (EPI) is the inability to properly digest food due to a lack or reduction of digestive enzymes made by the pancreas. EPI can occur in humans and is prevalent in many conditions such as cystic fibrosis, Shwach ...
, liver disease
Liver disease, or hepatic disease, is any of many diseases of the liver. If long-lasting it is termed chronic liver disease. Although the diseases differ in detail, liver diseases often have features in common.
Liver diseases
File:Ground gla ...
, or lung disease
The lungs are the primary organs of the respiratory system in many animals, including humans. In mammals and most other tetrapods, two lungs are located near the backbone on either side of the heart. Their function in the respiratory syst ...
because it involves duodenal absorption, 13C metabolism in the liver, and pulmonary exhalation of 13CO2. Physical activity is another factor that can influence CO2 excretion.
Wireless motility capsule
The US Food and Drug Administration
The United States Food and Drug Administration (FDA or US FDA) is a federal agency of the Department of Health and Human Services. The FDA is responsible for protecting and promoting public health through the control and supervision of food ...
has approved the wireless motility capsule (WMC) for the evaluation of gastric emptying as well as colonic transit time for individuals with suspected slow transit constipation
Constipation is a bowel dysfunction that makes bowel movements infrequent or hard to pass. The Human feces, stool is often hard and dry. Other symptoms may include abdominal pain, bloating, and feeling as if one has not completely passed the ...
. The capsule is 26.8 mm long and 11.7 mm wide, and it contains three sensors for temperature, pH, and pressure. Once ingested, the WMC continuously records measurements of the three variables as it moves through the gastrointestinal tract, and the information is wirelessly and in real-time transmitted to a receiver that the patient wears on their waist for the duration of the study.
Patients consume a standardized meal that includes a nutrient bar accompanied by 50 cc of water on the day of testing. Patients must fast for 6 hours after consuming a meal. For the duration of the study, they are asked to press the EVENT button, record specific events in a diary, and then the receiver is gathered and the data is downloaded for analysis.
Gastric emptying time is regarded as delayed if it is 5 hours or longer and is defined as the time required for the capsule to reach the duodenum, as determined by a pH increase of more than 3 units. Small bowel transit time is normally 2.5–6 hours and is calculated from when the pH increases by more than three units to when it drops by more than one unit and is sustained for at least 30 minutes. This drop denotes the capsule's passage to the cecum
The cecum ( caecum, ; plural ceca or caeca, ) is a pouch within the peritoneum that is considered to be the beginning of the large intestine. It is typically located on the right side of the body (the same side of the body as the appendix (a ...
. The colon transit period (normal is 59 hours or less) is calculated from the time the WMC enters the cecum till it is expelled from the body, as indicated by a sudden drop in temperature or signal loss.
Recent studies have also shown that luminal pressure measurements can be used to differentiate diabetic gastroparesis, which is characterized by reduced amount of contractions and motility indices when compared to healthy individuals. The ability to examine extragastric motility with a single test is another advantage of using WMC to diagnose gastroparesis. This is useful because extragastric impaired motility occurs in more than 40% of those with suspected gastroparesis, and gastrointestinal symptoms do not correlate well with the gastrointestinal segment affected. Assessing the rest of the gastrointestinal tract in addition to gastric emptying provides information about motility in various segments of the gut, which can change management and improve symptoms.
Antroduodenal manometry
Antroduodenal manometry involves endoscopically or under radiographic fluoroscopy
Fluoroscopy (), informally referred to as "fluoro", is an imaging technique that uses X-rays to obtain real-time moving images of the interior of an object. In its primary application of medical imaging, a fluoroscope () allows a surgeon to see t ...
inserting a manometry catheter or transducer
A transducer is a device that Energy transformation, converts energy from one form to another. Usually a transducer converts a signal in one form of energy to a signal in another.
Transducers are often employed at the boundaries of automation, M ...
with pressure sensors into the pyloric channel to obtain information about gastric and duodenal contractions. Fasting and postprandial
Prandial relates to a meal. Postprandial (from post prandium) means after eating a meal, while preprandial is before a meal.
Usages of postprandial
The term ''postprandial'' is used in multiple contexts.
Gastronomic or social
Refers to activiti ...
states are used to measure the pressure of the antral, pyloric, and duodenal contraction waves. The test can be performed in a stationary setting for 5–8 hours or in an ambulatory setting for 24 hours to evaluate duodenal motor function. Antroduodenal manometry reveals a decreased antral motility index in gastroparesis.
Antroduodenal manometry aids in differentiating between myopathic (scleroderma
Scleroderma is a group of autoimmune diseases that may result in changes to the skin, blood vessels, muscles, and internal organs. The disease can be either localized to the skin or involve other organs, as well. Symptoms may include areas ...
, amyloidosis
Amyloidosis is a group of diseases in which abnormal proteins, known as amyloid fibrils, build up in tissue. There are several non-specific and vague signs and symptoms associated with amyloidosis. These include fatigue, peripheral edema, weigh ...
) and neuropathic (diabetes mellitus) causes of impaired motility. The test shows a decreased frequency and amplitude of migrating motor complexes in patients with a myopathic condition. The migrating motor complexes in patients whose disease has a neuropathic etiology have a normal amplitude, but they are ill-coordinated and cannot propagate. This test is not widely available, and more validation research is required. It is an invasive test that necessitates expertise to perform and comprehend the results. Furthermore, it is technically challenging, and the catheter
In medicine, a catheter ( ) is a thin tubing (material), tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. ...
may move from the pylorus while an individual is fed and the stomach dilates.
Other imaging tests
Although transabdominal ultrasonography and magnetic resonance imaging (MRI) have been proposed as noninvasive diagnostic tools for gastroparesis, their use is currently restricted to research.
By measuring changes in the antral area, two-dimensional ultrasonography
Medical ultrasound includes diagnostic techniques (mainly imaging) using ultrasound, as well as therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal body structures such as tendons, muscles, joints, ...
can provide information about gastric emptying, and complete gastric emptying is determined when the antral area returns to its preprandial baseline. Three-dimensional ultrasound can provide information on meal distribution and stomach volume. It has also been proposed to use duplex sonography
Medical ultrasound includes diagnostic techniques (mainly imaging) using ultrasound, as well as therapeutic applications of ultrasound. In diagnosis, it is used to create an image of internal body structures such as tendons, muscles, joints ...
to examine transpyloric flow as well as liquid contents. While ultrasound appears to be an appealing, safe technique, its use in the clinical setting is limited due to the significant expertise required and inadequate outcomes in obese patients.
Another appealing tool is MRI
Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to generate pictures of the anatomy and the physiological processes inside the body. MRI scanners use strong magnetic fields, magnetic field gradients, and rad ...
, which uses transaxial abdominal images to gauge gastric accommodation and emptying every 15 minutes. It can also distinguish between gastric meal and air and thus provide data on gastric emptying and secretions. It is, however, costly and necessitates specialized equipment; with the exception of research, it is not standardized across centers, limiting its use to research only.
Treatment
Treatment includes dietary modifications, medications to stimulate gastric emptying, medications to reduce vomiting, and surgical approaches.[
]
Diet
Dietary treatment involves low-fiber/low-residue diets and, in some cases, restrictions on fat or solids. Eating smaller meals, spaced two to three hours apart, has proved helpful. Avoiding foods like rice or beef that cause the individual problems, such as abdominal pain or constipation, will help avoid symptoms.
Pharmacotherapy
Dopamine antagonists
D2 receptor antagonists are used to treat gastroparesis by reversing dopamine
Dopamine (DA, a contraction of 3,4-dihydroxyphenethylamine) is a neuromodulatory molecule that plays several important roles in cells. It is an organic chemical of the catecholamine and phenethylamine families. It is an amine synthesized ...
's inhibition of acetylcholine
Acetylcholine (ACh) is an organic compound that functions in the brain and body of many types of animals (including humans) as a neurotransmitter. Its name is derived from its chemical structure: it is an ester of acetic acid and choline. Par ...
(ACh) release. This increases gastrointestinal contractility and resting tone, and improves motility in the stomach and proximal small bowel.[ Dopamine antagonist action in the ]central nervous system
The central nervous system (CNS) is the part of the nervous system consisting primarily of the brain, spinal cord and retina. The CNS is so named because the brain integrates the received information and coordinates and influences the activity o ...
(CNS) also prevents nausea and vomiting.
Domperidone
Domperidone, sold under the brand name Motilium among others, is a dopamine antagonist medication which is used to treat nausea and vomiting and certain gastrointestinal problems like gastroparesis (delayed gastric emptying). It raises the ...
may be accessed by the US FDA's Expanded Access
Expanded access or compassionate use is the use of an unapproved drug or medical device under special forms of investigational new drug, investigational new drug applications (IND) or Investigational device exemption, IDE application for devices, o ...
program.[ It is dosed 10–20 mg three times daily and at bedtime.][ But it is associated with an increased risk of cardiac dysrhythmias, hence its restricted availability.][ It is contraindicated in patients with corrected ]QT interval
The QT interval is a measurement made on an Electrocardiography, electrocardiogram used to assess some of the electrical properties of the heart. It is calculated as the time from the start of the QRS complex, Q wave to the end of the T wave, an ...
s of >470 ms in males or >450 ms in females.[
]Metoclopramide
Metoclopramide is a medication used to treat nausea, vomiting, gastroparesis, and gastroesophageal reflux disease. It is also used to treat migraine headaches.
Common side effects include feeling tired, diarrhea, akathisia, and tardive dyski ...
has more CNS adverse effects than domperidone and carries a US FDA boxed warning for tardive dyskinesia
Tardive dyskinesia (TD) is an iatrogenic disorder that results in involuntary repetitive body movements, which may include grimacing, sticking out the tongue or smacking the lips, which occurs following treatment with medication. Additional mo ...
, a potentially irreversible condition.[ There are clinical guidelines specifically to mitigate this risk in its use,] with doses limited to 5–10 mg orally before meals and at bedtime.[ A liquid formulation is recommended, and a new intranasal formulation is also available.][
]
Other prokinetics
Among motilin
Motilin is a 22-amino acid polypeptide hormone in the motilin family that, in humans, is encoded by the ''MLN'' gene.
Motilin is secreted by endocrine Mo cells (also referred to as M cells, which are not the same as the M cells, or microfold ...
agonists, erythromycin
Erythromycin is an antibiotic used for the treatment of a number of bacterial infections. This includes respiratory tract infections, skin infections, chlamydia infections, pelvic inflammatory disease, and syphilis. It may also be used ...
is well known to improve emptying of the stomach. Its prolonged use is limited by the development of tachyphylaxis
Tachyphylaxis (Greek ταχύς, ''tachys'', "rapid", and φύλαξις, ''phylaxis'', "protection") is a medical term describing an acute, sudden decrease in response to a drug after its administration (i.e., a rapid and short-term onset of drug ...
; therapeutic effects may wane after a few weeks of consistent use.[ ]Clarithromycin
Clarithromycin, sold under the brand name Biaxin among others, is an antibiotic used to treat various bacterial infections. This includes strep throat, pneumonia, skin infections, '' H. pylori'' infection, and Lyme disease, among others. Clari ...
and azithromycin
Azithromycin, sold under the brand names Zithromax (in oral form) and Azasite (as an eye drop), is an antibiotic medication used for the treatment of several bacterial infections. This includes otitis media, middle ear infections, strep throa ...
, though less studied for this indication, share the same mechanism of action
In pharmacology, the term mechanism of action (MOA) refers to the specific biochemical Drug interaction, interaction through which a Medication, drug substance produces its pharmacological effect. A mechanism of action usually includes mention o ...
and (limited) utility.[ Azithromycin has the fewest drug interactions of the three.
Prucalopride, a 5-HT4 receptor agonist, may also be tried, particularly if there is chronic constipation] (for which it is labeled in Europe and US).[ Some evidence suggests it may improve symptoms and quality of life in gastroparesis.][
Pyridostigmine, an ]acetylcholinesterase inhibitor
Acetylcholinesterase inhibitors (AChEIs) also often called cholinesterase inhibitors, inhibit the enzyme acetylcholinesterase from breaking down the neurotransmitter acetylcholine into choline and acetate, thereby increasing both the level an ...
, may facilitate emptying by increasing ACh in the gastrointestinal neuromusculature.[ It lacks rigorous clinical trials for this indication, but there is clinical experience with its ]off-label use Off-label use is the use of pharmaceutical drugs for an unapproved indication or in an unapproved age group, dosage, or route of administration. Both prescription drugs and over-the-counter drugs (OTCs) can be used in off-label ways, although mo ...
as a prokinetic in several gastrointestinal motility disorders.[
]
Other neuromodulators and antiemetics
The antidepressant mirtazapine
Mirtazapine, sold under the brand name Remeron among others, is an atypical antidepressant, atypical tetracyclic antidepressant, and as such is used primarily to treat Depression (mood), depression. Its effects may take up to four weeks but ca ...
has proven effective in the treatment of gastroparesis unresponsive to conventional treatment. This may be due to its antiemetic and appetite stimulant properties. Mirtazapine acts on the same serotonin
Serotonin (), also known as 5-hydroxytryptamine (5-HT), is a monoamine neurotransmitter with a wide range of functions in both the central nervous system (CNS) and also peripheral tissues. It is involved in mood, cognition, reward, learning, ...
receptor ( 5-HT3) as the popular antiemetic ondansetron
Ondansetron, sold under the brand name Zofran among others, is a medication used to prevent nausea and vomiting caused by chemotherapy, radiation therapy, migraines, or surgery. It is also effective for treating gastroenteritis. It can be giv ...
.
A variety of other central neuromodulators, including (but not limited to) other antidepressants, may be tried for symptoms like bloating and distention (and not only in the setting of gastroparesis, but also for disorders of gut–brain interaction, or DGBI). They may reduce visceral pain
Visceral pain is defined as pain that results from the activation of nociceptors of the thoracic, pelvic, or abdominal viscera (organs) in the human body. Visceral structures are highly sensitive to distension (stretch), ischemia and inflammation, ...
or hypersensitivity, especially of a postprandial nature. They may also be selected to address any possible psychiatric comorbidities.
Other agents
Sildenafil
Sildenafil, sold under the brand name Viagra among others, is a medication used to treat erectile dysfunction and pulmonary hypertension, pulmonary arterial hypertension. It is also sometimes used off-label for the treatment of certain sym ...
, which increases blood flow to the genital area in men, is used by some practitioners to stimulate the gastrointestinal tract in cases of diabetic gastroparesis.
Deprescribing
Gastroparesis presents with symptoms like those of slow gastric emptying caused by some opioid medications, some antidepressants, some allergy medications, some weight loss medications, and some antihypertensive
Antihypertensives are a class of drugs that are used to treat hypertension (high blood pressure). Antihypertensive therapy seeks to prevent the complications of high blood pressure, such as stroke, heart failure, kidney failure and myocardial infa ...
s. For gastroparesis patients, these medications may make the condition worse.
Drug development
Camicinal was an investigational motilin agonist that did not improve enteral feeding intolerance.
Other therapeutic interventions
In specific cases where treatment of chronic nausea and vomiting proves resistant to drugs, implantable gastric stimulation may be used. A medical device
A medical device is any device intended to be used for medical purposes. Significant potential for hazards are inherent when using a device for medical purposes and thus medical devices must be proved safe and effective with reasonable assura ...
is implanted that applies neurostimulation
Neurostimulation is the purposeful modulation of the nervous system's activity using invasive (e.g. microelectrodes) or Non-invasive procedure, non-invasive means (e.g. transcranial magnetic stimulation, transcranial electric stimulation such as ...
to the muscles of the lower stomach to reduce the symptoms. This is only done in refractory cases that have failed all medical management (usually at least two years of treatment).
Medically refractory gastroparesis may also be treated with a pyloromyotomy, which widens the gastric outlet by cutting the circular pylorus muscle. This can be done laparoscopically or endoscopically (called G-POEM). Vertical sleeve gastrectomy, a procedure in which a part or all of the affected portion of the stomach is removed, has shown some success in the treatment of gastroparesis in obese patients, even curing it in some instances. Further studies have been recommended due to the limited sample size of previous studies.
Prognosis
Long-term studies in gastroparesis patients show that it is not a benign disease and has significant morbidity
A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...
and a poor prognosis due to the limited options for treatment. The mortality rate
Mortality rate, or death rate, is a measure of the number of deaths (in general, or due to a specific cause) in a particular Statistical population, population, scaled to the size of that population, per unit of time. Mortality rate is typically ...
is highest in patients with decompensated gastroparesis who are more likely to develop complications. For example, one study discovered that over 6 years, 7% of those with gastroparesis died, with 22% requiring long-term enteral
Enteral administration is food or drug administration via the human gastrointestinal tract. This contrasts with parenteral nutrition or drug administration (Greek ''para'', "besides" + ''enteros''), which occurs from routes outside the GI tract, ...
or parenteral
In pharmacology and toxicology, a route of administration is the way by which a drug, fluid, poison, or other substance is taken into the body.
Routes of administration are generally classified by the location at which the substance is applied. ...
feeding. 26% of these patients failed to respond to medical treatment, and 6% had gastric electrical stimulation. The 10 patients who died succumbed to metabolic
Metabolism (, from ''metabolē'', "change") is the set of life-sustaining chemical reactions in organisms. The three main functions of metabolism are: the conversion of the energy in food to energy available to run cellular processes; the ...
issues, cardiac
The heart is a muscular organ found in humans and other animals. This organ pumps blood through the blood vessels. The heart and blood vessels together make the circulatory system. The pumped blood carries oxygen and nutrients to the tissu ...
complications, renal failure
Kidney failure, also known as renal failure or end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney fa ...
, suicide
Suicide is the act of intentionally causing one's own death.
Risk factors for suicide include mental disorders, physical disorders, and substance abuse. Some suicides are impulsive acts driven by stress (such as from financial or ac ...
, and bowel ischemia
Intestinal ischemia is a medical condition in which injury to the large or small intestine occurs due to not enough blood supply. It can come on suddenly, known as acute intestinal ischemia, or gradually, known as chronic intestinal ischemia. The ...
caused by adhesions.
Other research indicates that diabetic
Diabetes mellitus, commonly known as diabetes, is a group of common endocrine diseases characterized by sustained high blood sugar levels. Diabetes is due to either the pancreas not producing enough of the hormone insulin, or the cells of th ...
gastroparesis is associated with an increased risk of morbidity
A disease is a particular abnormal condition that adversely affects the structure or function of all or part of an organism and is not immediately due to any external injury. Diseases are often known to be medical conditions that are asso ...
but not mortality. Olmsted County residents who had definite gastroparesis symptoms, as well as diagnostic testing for gastroparesis, had a 5-year estimated survival rate of 67%, which was significantly lower than the population average. Old age at the time of diagnosis has been linked to a lower chance of survival. Nondiabetic gastroparesis has been linked to a higher survival rate than diabetic gastroparesis.
Some evidence suggests that post-viral gastroparesis has a better prognosis and lasts less time than idiopathic
An idiopathic disease is any disease with an unknown cause or mechanism of apparent spontaneous origin.
For some medical conditions, one or more causes are somewhat understood, but in a certain percentage of people with the condition, the cause ...
gastroparesis. Cases of post-infectious gastroparesis are self-limiting, with recovery within 12 months of initial symptoms, although some cases last well over 2 years. In children, the duration tends to be shorter and the disease course milder than in adolescents and adults.
Prevalence
Post-infectious gastroparesis, which constitutes the majority of idiopathic gastroparesis cases, affects up to 4% of the US population. Women in their 20s and 30s seem to be susceptible. One study of 146 US gastroparesis patients found the mean age of patients was 34 years, with 82% affected being women, while another study found the patients were young or middle-aged and up to 90% were women.[
There has only been one true epidemiological study of idiopathic gastroparesis which was completed by the Rochester Epidemiology Project.] They looked at patients from 1996 to 2006 who were seeking medical attention instead of a random population sample and found that the prevalence of delayed gastric emptying was fourfold higher in women. It is difficult for medical professionals and researchers to collect enough data and provide accurate numbers since studying gastroparesis requires specialized laboratories and equipment.
See also
* Autoimmune gastrointestinal dysmotility
*Enteric nervous system
The enteric nervous system (ENS) is one of the three divisions of the autonomic nervous system (ANS), the others being the sympathetic nervous system (SNS) and parasympathetic nervous system (PSNS). It consists of a mesh-like system of neurons th ...
* Intestinal pseudo-obstruction, or enteric neuropathy
References
Further reading
*
*
*
External links
Overview
from NIDDK National Institute of Diabetes, Digestive, and Kidney Diseases at NIH
Gastrostars - Patients organization for everyone with a stomach paralysis and other additional physical conditions such as a paralyzed or slow working intestines.
{{Digestive system diseases
Congenital disorders of digestive system
Gastrointestinal motility disorders
Stomach disorders