View source for Gastroparesis

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  DiseasesDB     = 32575 |
  ICD10          = {{ICD10|K|31|8|k|20}} |
  ICD9           = {{ICD9|536.3}} |
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  OMIM           = |
  MedlinePlus    = 000297 |
  eMedicineSubj  = |
  eMedicineTopic = |
  MeshID         = D018589 |
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==Overview==

'''Gastroparesis''', also called delayed gastric emptying, is a medical condition consisting of a [[paresis]] (partial [[paralysis]]) of the [[stomach]] ("gastro-"), resulting in food remaining in the stomach for a longer period of time than normal. Normally, the stomach contracts to move food down into the [[small intestine]] for digestion. The [[vagus nerve]] controls these contractions. Gastroparesis may occur when the [[vagus nerve]] is damaged and the muscles of the stomach and intestines do not work normally. Food then moves slowly or stops moving through the digestive tract.

==Causes==

Gastroparesis may be chronic or transient; transient gastroparesis may arise in acute illness of any kind, with the use of certain cancer treatments or other drugs which affect digestive action, or due to [[anorexia]], [[bulimia]] and other abnormal eating patterns.

Chronic gastroparesis is frequently due to [[autonomic neuropathy]].  This may occur in people with [[type 1 diabetes]] or [[type 2 diabetes]]. The vagus nerve becomes damaged by years of high blood glucose, resulting in gastroparesis.  Gastroparesis has also been associated with various [[autoimmune disease]]s and syndromes, such as [[fibromyalgia]] and [[Parkinson's disease]], and may occur as part of a mitochondrial disorder.

Chronic gastroparesis can also be caused by other types of damage to the vagus nerve, such as [[abdominal surgery]].<ref>[http://www.mayoclinic.com/health/gastroparesis/DS00612/DSECTION=3 Gastroparesis: Causes - MayoClinic.com<!-- Bot generated title -->]</ref>

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 [[viral infection|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.

==Signs and Symptoms==

The most common symptoms of gastroparesis are<ref>[http://www.mayoclinic.com/health/gastroparesis/DS00612/DSECTION=symptoms Gastroparesis:  Symptoms - MayoClinic.com]</ref>

*Chronic nausea
*Vomiting (especially of undigested food)
*Early satiety

Other symptoms include 

*Heartburn 
*Weight loss 
*Abdominal bloating 
*Erratic blood glucose levels 
*Lack of appetite 
*Gastroesophageal reflux 
*Spasms of the stomach wall

==Diagnosis and Treatment==

Gastroparesis can be diagnosed with tests such as [[x ray]]s, [[manometry]], and [[gastric emptying scan]]s.  The clinical definition for gastroparesis is based solely on the emptying time of the stomach and not on other symptoms, and severity of symptoms does not necessarily correlate with the severity of gastroparesis.  Therefore, some patients may have marked gastroparesis with few, if any, serious complications.

Treatment includes dietary changes (low-fiber and low-residue diets, and in some cases, restrictions on fat and/or solids), oral medications such as [[Metoclopramide]] (Reglan, Maxolon, Clopra), [[Cisapride]] (Propulsid), [[Erythromycin]] (E-Mycin, Erythrocin, Ery-Tab, EES) and [[Domperidone]] (Motilium); adjustments in insulin dosage for those with [[diabetes]], a [[jejunostomy tube]], [[parenteral nutrition]], implanted gastric neurostimulators ("[[stomach pacemaker]]s"), or [[botulinum toxin]]. 

[[Viagra]], which increases blood flow to the genital area, is also being used by some practitioners to stimulate the GI tract in diabetic gastroparesis.  

The antidepressant [[Mirtazapine]] has also proven effective in the treatment of gastroparesis unresponsive to conventional treatment.  This is due to its anti-emetic and appetite stimulant properties.  Mirtazapine acts on the same serotonin receptor as the popular anti-emetic [[Ondansetron]]<ref>[http://psy.psychiatryonline.org/cgi/content/full/47/5/440 Mirtazapine for Severe Gastroparesis Unresponsive to Conventional Prokinetic Treatment]</ref>.

==Complications==

Primary complications of gastroparesis include:

* Fluctuations in [[blood glucose]] due to unpredictable digestion times (in diabetic patients)
* General malnutrition due to the symptoms of the disease (which frequently include vomiting and reduced appetite) as well as the dietary changes necessary to manage it
* Severe fatigue and weight loss due to calorie deficit
* [[Intestinal obstruction]] due to the formation of [[bezoar]]s (solid masses of undigested food)
* [[Bacterial infection]] due to overgrowth in undigested food

==External links==
* [http://www.mayoclinic.com/health/gastroparesis/DS00612 Overview] at [[Mayo Clinic]]
* [http://www.uchospitals.edu/online-library/content=P00370 Overview] at [[University of Chicago Hospitals]]

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{{Gastroenterology}}

[[Category:Gastroenterology]]

[[pl:Gastropareza]]
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