Ver el código de «Gastroparesis»

==Background<ref>Parkman HP, Hasler WL, Fisher RS. American Gastroenterlogical Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004; 127(5): 1592-1622.</ref>==
*Chronic GI disorder characterized by delayed gastric emptying ''without'' mechanical obstruction 
*More common in women, presumed due to elevated progesterone
*Symptoms overlap with functional dyspepsia

===Causes of Non-Obstructive Delayed Gastric Emptying===
*Idiopathic (most common)
*[[Diabetes mellitus]]
*Postsurgical/Vagal nerve injury 
*GI disorders associated with delayed emptying:
**[[GERD]], [[Achalasia]]
**Atrophic [[gastritis]], celiac disease
**Functional [[dyspepsia]]
**Hypertrophic [[pyloric stenosis]]
*Non-GI conditions/risk factors associated with delayed gastric emptying
**Medications: [[opioids]], [[anticholinergics]], [[PPI]]s, [[alcohol]], tobacco, progesterone
**Eating disorders: [[Anorexia nervosa]]
**[[Parkinson's disease]] and other neurologic disorders 
**[[Collagen vascular disease]]
**Parathyroid/[[thyroid disorder]]
**Chronic renal insufficiency 
**Malignancy
**Ischemic gastroparesis

==Clinical Features==
*Variable symptoms
*Early satiety, bloating, upper abdominal discomfort
*[[Nausea/vomiting]] 
*[[Abdominal pain]] (''not'' predominant symptom)
*[[Dehydration]], [[malnutrition]] if longstanding disease

==Differential Diagnosis==
{{Nausea and vomiting DDX}}
===Gastroparesis (by organ system)===
*GI
**[[Peptic ulcer disease]]
**Mechanical Obstruction
***Adhesion
***[[Small bowel obstruction]]/LBO
***Gastric outlet obstruction/[[Pyloric stenosis]]
***[[Volvulus]]
***Strangulated [[hernia]]
**[[Pancreatitis]]
**[[Appendicitis]]
**[[Cholecystitis]], [[Cholangitis]]
**[[Acute Hepatitis]]
**[[IBD]]
**[[Intussusception]]
**Malignancy 
**[[Mesenteric ischemia]]
**Esophageal disorders (e.g. [[achalasia]], [[GERD]], [[esophagitis]])
**Functional disorders such as [[Irritable Bowel Syndrome]]
*Neurologic
**[[Cannabinoid hyperemesis syndrome]]
*Infectious
**[[Spontaneous bacterial peritonitis]]
**[[Urinary tract infection]]
**[[bacterial disease|Bacterial]] toxins, [[viruses]] ([[adenovirus]], [[norovirus]], [[rotavirus]])
*Drugs/Toxins
**[[Heavy metal toxicity]]
**[[Methanol toxicity]]
*Endocrine
**[[Diabetic ketoacidosis]]
**[[Thyroid disorder]]
**Parathyroid disorders
**[[Uremia]]
*Miscellaneous
**[[Anorexia nervosa]], [[Bulimia nervosa]]

==Evaluation==
[[File:GastroparesisXray.jpg|thumb|Simple abdominal X-ray reveals a large amount of material in the stomach, suggesting severe gastric hypomotility.]]
*Definitive diagnosis of gastroparesis not typically made in ED
**Gold standard is gastric emptying scintigraphy of a solid-phase meal
**Other studies assessing emptying: tests, upper GI barium study, ultrasound for changes in antral area
*ED workup to exclude alternative diagnoses and complications (e.g. [[dehydration]], [[Electrolyte abnormalities]])
*CBC, BMP, [[LFTs]], lipase
*[[Urinalysis]], uHCG
*Consider: 
**[[ECG]] (if >50 or at risk for cardiac disease)
**[[RUQ US]]
**[[Acute abdominal series]] including an upright CXR (if risk for perforated ulcer)
**CT abdomen/pelvis to rule out obstruction
**Upper endoscopy or radiographic upper GI series to exclude mechanical obstruction or ulcer disease

==Management==
===ED Management===
*[[IVF]], [[Electrolyte repletion]]
*[[Antiemetics]]
**Dopamine receptor antagonists: [[Haloperidol]], [[Prochlorperazine]], [[promethazine]], trimethobenzamide
***[[Haloperidol]] has been shown to reduce the rate of admission and morphine equivalent doses of analgesia<ref>Ramirez R, Stalcup P, Croft B, Darracq MA. Haloperidol undermining gastroparesis symptoms (HUGS) in the emergency department. Am J Emerg Med. 2017;35(8):1118-1120. doi:10.1016/j.ajem.2017.03.015</ref>
**[[Ondansetron]]
*Prokinetic agents: enhance gut contractility
**[[Metoclopramide]] 
***Also has antiemetic properties
***PRN and/or standing dose prior to meals and bedtime
**[[Erythromycin]] 125-350mg TID or QID
*Refractory disease: 
**[[Nasogastric tube]] to decompress stomach
**Advanced therapies (not in ED) may include: placement of jejunostomy and/or [[G-tube complications|gastrostomy tube]], pyloric injection of botulinum toxin, [[Gastric pacemaker complication|gastric electric stimulation]]
*Prevention of future exacerbations:
**Review medications,  [[opioids]], [[anticholinergics]], [[PPI]]s may worsen or trigger symptoms
**Avoid carbonated beverages, [[alcohol]], and [[tobacco]]
**Optimize glycemic control in patients with [[diabetes]] ([[hyperglycemia]] alone can delay gastric emptying)
**Dietary: smaller but more frequent meals, minimize fat/fiber, increase liquid nutrient component

==Complications==
*[[Acute Gastric Dilation]]
*[[Esophagitis]], [[Mallory-Weiss tear]]
*[[Bezoar]]
*[[Dehydration]], [[malnutrition]], [[electrolyte abnormalities]]

==Disposition==
*Discharge with outpatient follow up unless:
**Inability to tolerate PO
**Need for ongoing IV rehydration, electrolyte correction, and/or glycemic control

==See Also==
*[[Diabetes mellitus]]
*[[Nausea/vomiting]]

==External Links==

==References==
<references/>


[[Category:GI]]