GASTROPARESIS
Gastroparesis is a chronic symptomatic disorder of the stomach characterized by delayed emptying without evidence of mechanical obstruction. The delay in gastric emptying can have a number of causes, including antral hypomotility, pylorospasm, gastric dysthymias, and lack of interstitial cells of Cajal. Symptoms from gastroparesis include nausea, vomiting, early satiety, postprandial fullness, and, in some patients, upper abdominal pain. This classic motility disorder of the stomach can lead to marked dysfunction in patients, with a poor quality of life. Gastroparesis is identified by recognizing the clinical symptoms and documenting delayed gastric emptying. The three main causes are diabetic, postsurgical, and idiopathic.
Management
of gastroparesis includes assessing and correcting dehydration and
malnutrition, if present; maintaining nutritional intake; relieving symptoms;
improving gastric emptying; and, in diabetics, controlling glycemia. The
nutritional state should be managed by oral dietary modifications. Medical
treatment entails use of
prokinetic and antiemetic therapies. Although in many patients symptoms can be
controlled with medical therapy, some patients remain markedly symptomatic,
with progressive weight loss.
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| ASSOCIATED GASTRIC/ESOPHAGEAL DISEASE |
For
refractory cases, a jejunostomy feeding tube, gastric electric stimulator, and
pyloromyotomy may need to be considered. Unfortunately, current approved
treatment options do not adequately address the clinical need. Attention is
being given to the development of new effective therapies for symptomatic control.
