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Gastroparesis Diagnosis and Treatment

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Gastroparesis Diagnosis and Treatment

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  2. Anatomical and Functional regions of the Stomach

  3. Migrating Motor Complex

  4. Etiology of Gastroparesis • Diabetes-related • Metabolic hyper-glycemia, hypo-kalemia, hypermagnesemia • Hypo-pituitarism, hypo-adrenalism, hypo-thyroidism • Chronic renal failure • Portal hypertension • Intra-abdominal malignancy • Infectious: H. pylori., EBV • Rheumatological: Systemic sclerosis, SLE, • Myotonic dystrophies • Central Nervous System disorders (Parkinson’s disease, multiple sclerosis) • Peripheral Nervous System disorders (amyloid neuropathy, Guillain-Barre, primary dysautonomia) • Psychiatric disorders (anorexia nervosa, rumination syndrome)

  5. Surgery Related Etiology of Gastroparesis • Vagotomy, • Duodenectomy • Mechanical Obstruction Partial

  6. Drugs that delay Gastric Emptying • Alcohol • Aluminium hydroxide antacids • Atropine • beta-Agonists • Calcium channel blockers • Diphenhydramine • L-Dopa • Lithium • Ondansetron • Opiates • Phenothiazines • Tricyclic anti-depressants

  7. Gastric Inhibitory Hormones

  8. Gastric Stimulatory Hormones

  9. Anti-emetic agents • Prochlorperazine Compazine • Tardive dyskinesia • Promethazine • 5-hydroxytryptamine receptor agonist (i.e. odansetron) • Reduce dose with hepatic disease

  10. Botulinum Toxin A for the Treatment of Delayed Gastric EmptyingAm J Gastro 103; 416-423, 2008 Placebo and Botox improved symptoms and gastric emptying

  11. Prokinetic agents • Metoclopramide (reglan) • Antral contractions • Extrapyramidal symptoms • Erythromycin • Motolin agonist • Induces phase III MMC • Cardiac arrhythmias • Domperidone. • Not marketed in US • Cisapride • cardiac arrhythmias FDA removed from use

  12. Enterra Neurostimulator

  13. Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis Dig Dis Sci (2008) 53:2072–2078

  14. Ileal brake is most potent inhibitory feedback Companion brakes work in absence of ileal brake Ileal Brake

  15. Fats in ileum trigger release of Peptide YY Peptide YY inhibits gastric emptying Ileal Brake

  16. Resectional Therapy • Subtotal gastrectomy • Roux-en-Y reconstruction • Preop measurement of vitamin D, Thiamine, B-12, folate, iron

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