Gastroparesis
Gastroparesis is delayed gastric emptying without mechanical obstruction, most often from longstanding diabetes, prior gastric surgery, or an idiopathic postviral course, presenting with nausea, vomiting, early satiety, and postprandial fullness. Diagnosis requires upper endoscopy to exclude obstruction followed by objective gastric emptying testing, and management progresses from glycemic control and dietary change through time-limited prokinetics to device or endoscopic therapy for refractory disease.
- Topic reviewThe full article, organized the way the exam asks it.
- ABIM-format MCQsVignettes with an explanation for every wrong answer.
- Key factsThe numbers and thresholds worth memorizing, up front.
- AI tutorMedBrain answers the question you're stuck on.
What this article covers
- Overview
Definition: gastroparesis is a heterogeneous clinical syndrome defined by the combination of compatible upper gastrointestinal symptoms, the absence of mechanical gastric outlet obstruction, and…
- Epidemiology
Diabetic gastroparesis is the largest defined subgroup: about 40% of patients with long-standing type 1 diabetes and 20% with type 2 diabetes develop the syndrome.
- Risk factors
Long-standing diabetes mellitus: the dominant risk factor, more common with type 1 than type 2 disease and associated with poor glycemic control.
- Pathophysiology
Autonomic and enteric neuropathy in diabetes: chronic hyperglycemia damages vagal and enteric neurons and interstitial cells of Cajal, the pacemaker cells generating gastric slow waves, impairing…
- Clinical features
Nausea: the most prevalent symptom, present in about 90% of patients.
- Differential diagnosis
Gastric outlet obstruction: a mechanical lesion (peptic stricture, malignancy, bezoar) produces identical symptoms but is excluded by upper endoscopy, which is why endoscopy always precedes an emptying study.
- Diagnosis
Establish the diagnosis by the combination of compatible symptoms, absence of gastric outlet obstruction or ulceration, and an objectively confirmed delay in gastric emptying, per American College of…
- Management
Correct reversible drivers first: rehydrate and correct electrolyte abnormalities, provide nutritional support if intake is inadequate, and stop or substitute opioids and anticholinergic agents that are slowing gastric emptying.
- Complications
Malnutrition and dehydration: from chronic reduced intake and recurrent vomiting, the principal drivers of hospitalization.
- Prognosis
Course depends on etiology: postviral idiopathic gastroparesis frequently improves or resolves over time, while diabetic and postsurgical gastroparesis tend to follow a more chronic course.
- Prevention
Maintain blood glucose below 200 mg/dL (11.1 mmol/L) in patients with diabetes to prevent both the onset and the acute worsening of delayed gastric emptying.
Read the whole article
Subscribing to Internal Medicine opens every article, the full question bank and MedBrain, on the web, iPhone and Android.
Related articles
- Dyspepsia
Dyspepsia is chronic or recurrent epigastric pain, burning, postprandial fullness, or early satiety that is organic when a structural, metabolic, or drug cause is found and functional when Rome IV criteria are met after a negative workup. Management starts with an alarm-feature screen that mandates prompt upper endoscopy, then test-and-treat for Helicobacter pylori, then an empiric proton pump inhibitor trial, reserving a tricyclic or prokinetic agent for confirmed functional disease.
- Dumping syndrome
Dumping syndrome follows rapid emptying of hyperosmolar gastric contents into the small bowel after gastric surgery, producing early gastrointestinal and vasomotor symptoms within 30 minutes of eating or late reactive hypoglycemia 1 to 3 hours after eating. Diagnosis is clinical from the postoperative time course, supported by an oral glucose challenge, and treatment starts with dietary modification before escalating to acarbose or octreotide.
- Type 2 diabetes mellitus
Type 2 diabetes is hyperglycemia from insulin resistance with progressive relative insulin deficiency, diagnosed by a hemoglobin A1c of 6.5% or higher, a fasting glucose of 126 mg/dL or higher, or a 2-hour oral glucose tolerance test value of 200 mg/dL or higher. First-line treatment is lifestyle modification plus metformin, with an SGLT2 inhibitor or GLP-1 receptor agonist added early for patients with atherosclerotic disease, kidney disease, or heart failure.
- Gastroesophageal reflux disease (GERD)
GERD is retrograde reflux of gastric contents into the esophagus causing heartburn and regurgitation, diagnosed clinically and confirmed by response to an empiric PPI trial, with endoscopy reserved for alarm features or refractory symptoms. Management proceeds from lifestyle measures through an 8-week once-daily PPI trial, dose escalation or agent switch for partial response, and fundoplication for medication-refractory or regurgitation-predominant disease.
- Diabetic neuropathy
Diabetic neuropathy is length-dependent nerve damage from chronic hyperglycemia, most often a distal symmetric sensorimotor polyneuropathy causing numbness, pain, and loss of ankle reflexes, with autonomic, mononeuropathy, and radiculoplexus variants. Diagnosis is clinical after excluding other causes; management is tight glycemic control plus gabapentinoid or duloxetine therapy for painful symptoms.