Gastroparesis

Causes

• Diabetes mellitus (commonly with other evidence of autonomic neuropathy).
• Other systemic diseases — thyroid disease, chronic renal failure, reflux oesophagitis, scleroderma, dermatomyositis, polymyositis, myotonic dystrophy.
• Upper GI surgery (e.g. vagotomy, gastric surgery).
• Drugs that delay gastric emptying — e.g. opioids, GLP-1 analogues.

Clinical features

Bloating; epigastric fullness; early satiety; nausea and vomiting.

Diagnosis

Upper GI endoscopy is recommended to exclude a mechanical cause of obstruction. If endoscopy is normal, a nuclear medicine gastric emptying study should be performed to confirm the diagnosis.

Management

Dietary modification: small, frequent meals of soft or easily macerated foods; chew food well; avoid high-fat and high-fibre foods; a fully pureed or liquid diet if needed (gastric emptying of liquids is generally preserved in gastroparesis). Dietitian referral, especially for patients with comorbidities (e.g. diabetes). Refer for jejunal feeding if nutrition can’t be maintained by oral intake.

Drug therapy: a prokinetic is first-line — try domperidone 10mg orally three times daily before meals. If ineffective, metoclopramide may be considered, but should be stopped if symptoms don’t improve and not used for longer than 5 days.