Gastroparesis causes
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Madhu Sigdel M.B.B.S.[2] Farman Khan, MD, MRCP [3]
Overview
The etiology of gastroparesis can be broadly classified into idiopathic, diabetic, post-surgical and medication induced. Life threatening causes of gastroparesis include brainstem stroke and hypokalemia (which may lead to cardiac arrythmias). Surgical procedures most commonly associated with gastroparesis include distal gastrectomy, pancreatoduodenectomy, cholecystectomy and fundoplication. Common medications associated with the development of gastroparesis include narcotics, tricyclic antidepressants, octreotide, amylin analogues, dopamine analogues and phenothiazines.
Causes
Life threatening causes
Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated.
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Common causes
- Idiopathic[1][2]
- Diabetes mellitus (Type II is more common cause than type I DM)[1] - second commonest cause
- Post- surgical: Distal gastrectomy for cancer of stomach, pancreatoduodenectomy, cholecystectomy, fundoplication etc[3]
- Narcotics
- Phenothiazines
- Pregnancy
- Scleroderma
- Systemic sclerosis
- Vagotomy
Less common causes
Transient gastroparesis may arise in acute illness of any kind:
- Certain cancer treatments or other drugs which affect digestive action
- Anorexia
- Bulimia
- Other abnormal eating patterns
- Medications (anticholinergics and narcotics) that slow contractions in the intestine
Chronic gastroparesis is frequently due to autonomic neuropathy:
- Type 1 diabetes or type 2 diabetes:
- The vagus nerve becomes damaged by years of high blood glucose, resulting in gastroparesis
- Fibromyalgia
- Parkinson's disease
- Mitochondrial disorder
- Abdominal surgery[4]
- Amyloidosis
- Scleroderma
- Abdominal migraine
- Hypothyroidism
- Gastroesophageal reflux disease
Idiopathic gastroparesis (gastroparesis with no known cause) accounts for a third of all chronic cases; it is thought that many of these cases are due to an autoimmune response triggered by an acute viral infection:
- Stomach flu
- Mononucleosis, and others have been anecdotally linked to the onset of the condition, but no systematic study has proven a link
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Causes by Organ System
| Cardiovascular | Percutaneous catheter ablation for atrial fibrillation; prevalence of gastroparesis after radio-frequency ablation is 10% and cryoablation procedures is 6%, respectively.[5] |
| Chemical/Poisoning | No underlying causes |
| Dental | No underlying causes |
| Dermatologic | No underlying causes |
| Drug Side Effect | Tricyclic antidepressants, phenothiazines, octreotide, narcotics, muscarinic cholinergic receptor antagonists,
glucagon-like peptide (GLP)-1 agonists, amylin analogues, dopamine agonists, cholangiocarcinoma, calcium channel blockers, anticholinergics, alpha-2-adrenergic agonists |
| Ear Nose Throat | No underlying causes |
| Endocrine | Hypothyroidism, hypoparathyroidism, diabetes mellitus type 2, diabetes mellitus type 1 |
| Environmental | No underlying causes |
| Gastroenterologic | Ulcers in first portion of duodenum, pyloric stenosis, pyloric channel ulcer, pancreatic pseudocyst, pancreatic cancer,
gastroesophageal reflux disease, gastric polyps, gastric cancer, duodenal cancer, abdominal migraine |
| Genetic | No underlying causes |
| Hematologic | No underlying causes |
| Iatrogenic | Surgery on the stomach or vagus nerve, complication of stomach surgery for ulcer disease or weight loss, vagotomy |
| Infectious Disease | Rotavirus, postviral syndromes, Norwalk virus, AIDS, acute viral infection |
| Musculoskeletal/Orthopedic | No underlying causes |
| Neurologic | Primary dysautonomias, Parkinson's disease, brainstem stroke or tumor, autonomic neuropathy, autoimmune gastrointestinal dysmotility |
| Nutritional/Metabolic | No underlying causes |
| Obstetric/Gynecologic | Pregnancy |
| Oncologic | Ampullary cancer |
| Ophthalmologic | No underlying causes |
| Overdose/Toxicity | No underlying causes |
| Psychiatric | Psychogenic, vomiting, depression, bulimia, anxiety, neurosis, anorexia nervosa |
| Pulmonary | Small cell lung cancer[6] |
| Renal/Electrolyte | Kidney failure, hypomagnesemia, hypokalemia |
| Rheumatology/Immunology/Allergy | Systemic sclerosis, scleroderma, polymyositis, lupus |
| Sexual | No underlying causes |
| Trauma | No underlying causes |
| Urologic | No underlying causes |
| Miscellaneous | Myotonic dystrophy, idiopathic, congenital obstruction, Bouveret syndrome, amyloidosis, amyloid neuropathy |
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Causes in Alphabetical Order
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References
- ↑ 1.0 1.1 Hyett B, Martinez FJ, Gill BM, Mehra S, Lembo A, Kelly CP; et al. (2009). "Delayed radionucleotide gastric emptying studies predict morbidity in diabetics with symptoms of gastroparesis". Gastroenterology. 137 (2): 445–52. doi:10.1053/j.gastro.2009.04.055. PMID 19410575.
- ↑ Bharucha AE (2015). "Epidemiology and natural history of gastroparesis". Gastroenterol Clin North Am. 44 (1): 9–19. doi:10.1016/j.gtc.2014.11.002. PMC 4323583. PMID 25667019.
- ↑ Glowka TR, Webler M, Matthaei H, Schäfer N, Schmitz V, Kalff JC; et al. (2017). "Delayed gastric emptying following pancreatoduodenectomy with alimentary reconstruction according to Roux-en-Y or Billroth-II". BMC Surg. 17 (1): 24. doi:10.1186/s12893-017-0226-x. PMC 5359898. PMID 28320386.
- ↑ Gastroparesis: Causes - MayoClinic.com
- ↑ Aksu T, Golcuk S, Guler TE, Yalin K, Erden I (2015). "Gastroparesis as a Complication of Atrial Fibrillation Ablation". Am J Cardiol. 116 (1): 92–7. doi:10.1016/j.amjcard.2015.03.045. PMID 25933733.
- ↑ Vaidya GN, Lutchmansingh D, Paul M, John S (2014). "Gastroparesis as the initial presentation of pulmonary adenocarcinoma". BMJ Case Rep. 2014. doi:10.1136/bcr-2014-207228. PMC 4265036. PMID 25498111.
- ↑ Sailer, Christian, Wasner, Susanne. Differential Diagnosis Pocket. Hermosa Beach, CA: Borm Bruckmeir Publishing LLC, 2002:77 ISBN 1591032016
- ↑ Kahan, Scott, Smith, Ellen G. In A Page: Signs and Symptoms. Malden, Massachusetts: Blackwell Publishing, 2004:68 ISBN 140510368X