Gastroparesis Guidelines
Hello. I'm Dr. David Johnson. Welcome back to another installment of GI Common Concerns -- Computer Consult.
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Today I want to discuss gastroparesis, because this is a fairly pragmatic conversation that I frequently have with patients. Someone comes in every day with abdominal pain, bloating, nausea, and early satiety. A variety of symptoms raise the possibility of gastroparesis. The American College of Gastroenterology recently published some very practical, updated guidelines on gastroparesis. I thought it would be helpful to review some of these recommendations and put into perspective how you can apply them to your patients who you think might have a gastroparetic condition.
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The definition of gastroparesis is a patient with evidence of delayed gastric emptying but no evidence of an outlet obstruction. The clinical spectrum can overlap with conditions such as functional dyspepsia or accelerated gastric emptying. The symptoms and the findings must correlate with objective evidence based on diagnostic testing.
Gastroparesis is a very common condition. It is prevalent in postsurgical patients, particularly after fundoplication. I see many of these patients in my practice. There are also idiopathic cases -- the patients for whom we don't have an explanation. Identifiable causes should be sought in every patient in whom you suspect a gastroparetic condition. The differential should include diabetes because it is prevalent in these patients. In community settings, 5% of patients with type 1 diabetes, 1% of patients with type 2 diabetes, and about 0.2% of nondiabetics have gastroparesis.
The writing committee for the American College of Gastroenterology recommends taking a good history, because often a gastroparetic condition will begin after a viral illness. Patients will say, "I felt fine until I got this illness and started having nausea and vomiting." Look for prodromal symptoms from a viral illness, and evaluate your patients for a history of diabetes, gastric surgery, fundoplication, thyroid disease, and endocrine and rheumatologic diseases. Patients should be appropriately tested if they have those disorders.
The recommendation is to test all patients for glycemic control with a hemoglobin A1c and thyroid disease. Directed testing should follow, depending on the finding of other evidence of autoimmune, rheumatologic, or neurologic diseases that can overlap with gastroparetic disease.