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Gastroparesis

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Description

Delayed gastric emptying in the absence of mechanical obstruction. Most commonly idiopathic or diabetic in etiology. Causes nausea, vomiting, early satiety, and bloating.

Key Features

  • Nausea and vomiting (often of undigested food hours after eating)
  • Early satiety and postprandial fullness
  • Bloating and upper abdominal pain
  • Diabetes mellitus (especially with neuropathy)
  • Confirmed delayed gastric emptying on scintigraphy

Diagnostic Criteria

  • Diagnosis requires ALL of:
  • 1. Symptoms of gastroparesis (nausea, vomiting, early satiety, bloating)
  • 2. Objective evidence of delayed gastric emptying (scintigraphy: > 10% retention at 4 hours)
  • 3. Absence of mechanical gastric outlet obstruction (confirmed by endoscopy or imaging)

Red Flags

  • • Severe dehydration
  • • Malnutrition/significant weight loss
  • • Bezoar formation
  • • Uncontrolled diabetes with gastroparesis

Differential Clues

Vomiting undigested food hours after eatingDiabetes with neuropathySuccussion splashNormal endoscopy but delayed scintigraphy
Sources: DynaMed. Gastroparesis. EBSCO Information Services. | ACG Guidelines on Gastroparesis 2013