Gastroparesis differential diagnosis: Difference between revisions

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__NOTOC__
__NOTOC__
{{Gastroparesis}}
[[Image:Home_logo1.png|right|250px|https://www.wikidoc.org/index.php/Gastroparesis]]
{{CMG}}
{{CMG}}; {{AE}} {{HK}}


==Overview==
==Overview==
Gastroparesis should be differentiated from other diseases that cause chronic [[nausea and vomiting]]. The differentials include psychiatric illnesses, rumination syndrome, funtional dyspepsia and cyclic vomiting syndrome.  
Gastroparesis should be differentiated from other diseases that cause chronic [[nausea and vomiting]]. The differentials include [[Psychiatric illness|psychiatric illnesses]], [[rumination syndrome]], [[functional dyspepsia]] and [[cyclic vomiting syndrome]].  


==Differentiating Gastroparesis from other Diseases==
==Differentiating Gastroparesis from other Diseases==
Gastroparesis should be differentiated from other diseases that cause chronic [[nausea and vomiting]]. The differentials include the following:<ref name="pmid25667023">{{cite journal |vauthors=Parkman HP |title=Idiopathic gastroparesis |journal=Gastroenterol. Clin. North Am. |volume=44 |issue=1 |pages=59–68 |year=2015 |pmid=25667023 |pmc=4324534 |doi=10.1016/j.gtc.2014.11.015 |url=}}</ref><ref name="pmid17015559">{{cite journal |vauthors=Werlin SL, Fish DL |title=The spectrum of valproic acid-associated pancreatitis |journal=Pediatrics |volume=118 |issue=4 |pages=1660–3 |year=2006 |pmid=17015559 |doi=10.1542/peds.2006-1182 |url=}}</ref><ref name="pmid16369243">{{cite journal |vauthors=Noddin L, Callahan M, Lacy BE |title=Irritable bowel syndrome and functional dyspepsia: different diseases or a single disorder with different manifestations? |journal=MedGenMed |volume=7 |issue=3 |pages=17 |year=2005 |pmid=16369243 |pmc=1681633 |doi= |url=}}</ref><ref name="pmid23226859">{{cite journal |vauthors=Gupta R, Kalla M, Gupta JB |title=Adult rumination syndrome: Differentiation from psychogenic intractable vomiting |journal=Indian J Psychiatry |volume=54 |issue=3 |pages=283–5 |year=2012 |pmid=23226859 |pmc=3512372 |doi=10.4103/0019-5545.102434 |url=}}</ref><ref name="urlBody weight in bulimia nervosa | SpringerLink">{{cite web |url=https://link.springer.com/article/10.1007/BF03339730 |title=Body weight in bulimia nervosa &#124; SpringerLink |format= |work= |accessdate=}}</ref><ref name="pmid25904280">{{cite journal |vauthors=Sağlam F, Sivrikoz E, Alemdar A, Kamalı S, Arslan U, Güven H |title=Bouveret syndrome: A fatal diagnostic dilemma of gastric outlet obstruction |journal=Ulus Travma Acil Cerrahi Derg |volume=21 |issue=2 |pages=157–9 |year=2015 |pmid=25904280 |doi= |url=}}</ref><ref name="pmid21475419">{{cite journal |vauthors=Talley NJ |title=Rumination syndrome |journal=Gastroenterol Hepatol (N Y) |volume=7 |issue=2 |pages=117–8 |year=2011 |pmid=21475419 |pmc=3061016 |doi= |url=}}</ref><ref name="pmid15067630">{{cite journal |vauthors=Tutuian R, Castell DO |title=Rumination documented by using combined multichannel intraluminal impedance and manometry |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=4 |pages=340–3 |year=2004 |pmid=15067630 |doi= |url=}}</ref><ref name="pmid24921208">{{cite journal |vauthors=Kessing BF, Smout AJ, Bredenoord AJ |title=Current diagnosis and management of the rumination syndrome |journal=J. Clin. Gastroenterol. |volume=48 |issue=6 |pages=478–83 |year=2014 |pmid=24921208 |doi=10.1097/MCG.0000000000000142 |url=}}</ref><ref name="pmid19232280">{{cite journal |vauthors=Parkman HP |title=Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and SmartPill |journal=Gastrointest. Endosc. Clin. N. Am. |volume=19 |issue=1 |pages=49–55, vi |year=2009 |pmid=19232280 |doi=10.1016/j.giec.2008.12.003 |url=}}</ref><ref name="pmid19115465">{{cite journal |vauthors=Waseem S, Moshiree B, Draganov PV |title=Gastroparesis: current diagnostic challenges and management considerations |journal=World J. Gastroenterol. |volume=15 |issue=1 |pages=25–37 |year=2009 |pmid=19115465 |pmc=2653292 |doi= |url=}}</ref><ref name="pmid3699409">{{cite journal |vauthors=Mearin F, Camilleri M, Malagelada JR |title=Pyloric dysfunction in diabetics with recurrent nausea and vomiting |journal=Gastroenterology |volume=90 |issue=6 |pages=1919–25 |year=1986 |pmid=3699409 |doi= |url=}}</ref><ref name="pmid18028513">{{cite journal |vauthors=Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape WJ, Ziessman HA |title=Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine |journal=Am. J. Gastroenterol. |volume=103 |issue=3 |pages=753–63 |year=2008 |pmid=18028513 |doi=10.1111/j.1572-0241.2007.01636.x |url=}}</ref><ref name="pmid12014357">{{cite journal |vauthors=Jiang CF, Ng KW, Tan SW, Wu CS, Chen HC, Liang CT, Chen YH |title=Serum level of amylase and lipase in various stages of chronic renal insufficiency |journal=Zhonghua Yi Xue Za Zhi (Taipei) |volume=65 |issue=2 |pages=49–54 |year=2002 |pmid=12014357 |doi= |url=}}</ref><ref name="SzmuklerYoung1990">{{cite journal|last1=Szmukler|first1=G. I.|last2=Young|first2=G. P.|last3=Lichtenstein|first3=M.|last4=Andrews|first4=J. T.|title=A serial study of gastric emptying in anorexia nervosa and bulimia|journal=Australian and New Zealand Journal of Medicine|volume=20|issue=3|year=1990|pages=220–225|issn=00048291|doi=10.1111/j.1445-5994.1990.tb01023.x}}</ref><ref name="pmid12827003">{{cite journal |vauthors=Diamanti A, Bracci F, Gambarara M, Ciofetta GC, Sabbi T, Ponticelli A, Montecchi F, Marinucci S, Bianco G, Castro M |title=Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders |journal=J. Pediatr. Gastroenterol. Nutr. |volume=37 |issue=1 |pages=35–41 |year=2003 |pmid=12827003 |doi= |url=}}</ref><ref name="pmid981449">{{cite journal |vauthors=Ferholt J, Provence S |title=Diagnosis and treatment of an infant with psychophysiological vomiting |journal=Psychoanal Study Child |volume=31 |issue= |pages=439–59 |year=1976 |pmid=981449 |doi= |url=}}</ref><ref name="pmid17914944">{{cite journal |vauthors=Lee H, Rhee PL, Park EH, Kim JH, Son HJ, Kim JJ, Rhee JC |title=Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study |journal=J. Gastroenterol. Hepatol. |volume=22 |issue=11 |pages=1741–7 |year=2007 |pmid=17914944 |doi=10.1111/j.1440-1746.2006.04617.x |url=}}</ref>
Gastroparesis should be differentiated from other diseases that cause chronic [[nausea and vomiting]]. The differentials include the following:<ref name="pmid25667023">{{cite journal |vauthors=Parkman HP |title=Idiopathic gastroparesis |journal=Gastroenterol. Clin. North Am. |volume=44 |issue=1 |pages=59–68 |year=2015 |pmid=25667023 |pmc=4324534 |doi=10.1016/j.gtc.2014.11.015 |url=}}</ref><ref name="pmid17015559">{{cite journal |vauthors=Werlin SL, Fish DL |title=The spectrum of valproic acid-associated pancreatitis |journal=Pediatrics |volume=118 |issue=4 |pages=1660–3 |year=2006 |pmid=17015559 |doi=10.1542/peds.2006-1182 |url=}}</ref><ref name="pmid16369243">{{cite journal |vauthors=Noddin L, Callahan M, Lacy BE |title=Irritable bowel syndrome and functional dyspepsia: different diseases or a single disorder with different manifestations? |journal=MedGenMed |volume=7 |issue=3 |pages=17 |year=2005 |pmid=16369243 |pmc=1681633 |doi= |url=}}</ref><ref name="pmid23226859">{{cite journal |vauthors=Gupta R, Kalla M, Gupta JB |title=Adult rumination syndrome: Differentiation from psychogenic intractable vomiting |journal=Indian J Psychiatry |volume=54 |issue=3 |pages=283–5 |year=2012 |pmid=23226859 |pmc=3512372 |doi=10.4103/0019-5545.102434 |url=}}</ref><ref name="urlBody weight in bulimia nervosa | SpringerLink">{{cite web |url=https://link.springer.com/article/10.1007/BF03339730 |title=Body weight in bulimia nervosa &#124; SpringerLink |format= |work= |accessdate=}}</ref><ref name="pmid25904280">{{cite journal |vauthors=Sağlam F, Sivrikoz E, Alemdar A, Kamalı S, Arslan U, Güven H |title=Bouveret syndrome: A fatal diagnostic dilemma of gastric outlet obstruction |journal=Ulus Travma Acil Cerrahi Derg |volume=21 |issue=2 |pages=157–9 |year=2015 |pmid=25904280 |doi= |url=}}</ref><ref name="pmid21475419">{{cite journal |vauthors=Talley NJ |title=Rumination syndrome |journal=Gastroenterol Hepatol (N Y) |volume=7 |issue=2 |pages=117–8 |year=2011 |pmid=21475419 |pmc=3061016 |doi= |url=}}</ref><ref name="pmid15067630">{{cite journal |vauthors=Tutuian R, Castell DO |title=Rumination documented by using combined multichannel intraluminal impedance and manometry |journal=Clin. Gastroenterol. Hepatol. |volume=2 |issue=4 |pages=340–3 |year=2004 |pmid=15067630 |doi= |url=}}</ref><ref name="pmid24921208">{{cite journal |vauthors=Kessing BF, Smout AJ, Bredenoord AJ |title=Current diagnosis and management of the rumination syndrome |journal=J. Clin. Gastroenterol. |volume=48 |issue=6 |pages=478–83 |year=2014 |pmid=24921208 |doi=10.1097/MCG.0000000000000142 |url=}}</ref><ref name="pmid19232280">{{cite journal |vauthors=Parkman HP |title=Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and SmartPill |journal=Gastrointest. Endosc. Clin. N. Am. |volume=19 |issue=1 |pages=49–55, vi |year=2009 |pmid=19232280 |doi=10.1016/j.giec.2008.12.003 |url=}}</ref><ref name="pmid19115465">{{cite journal |vauthors=Waseem S, Moshiree B, Draganov PV |title=Gastroparesis: current diagnostic challenges and management considerations |journal=World J. Gastroenterol. |volume=15 |issue=1 |pages=25–37 |year=2009 |pmid=19115465 |pmc=2653292 |doi= |url=}}</ref><ref name="pmid3699409">{{cite journal |vauthors=Mearin F, Camilleri M, Malagelada JR |title=Pyloric dysfunction in diabetics with recurrent nausea and vomiting |journal=Gastroenterology |volume=90 |issue=6 |pages=1919–25 |year=1986 |pmid=3699409 |doi= |url=}}</ref><ref name="pmid18028513">{{cite journal |vauthors=Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape WJ, Ziessman HA |title=Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine |journal=Am. J. Gastroenterol. |volume=103 |issue=3 |pages=753–63 |year=2008 |pmid=18028513 |doi=10.1111/j.1572-0241.2007.01636.x |url=}}</ref><ref name="pmid12014357">{{cite journal |vauthors=Jiang CF, Ng KW, Tan SW, Wu CS, Chen HC, Liang CT, Chen YH |title=Serum level of amylase and lipase in various stages of chronic renal insufficiency |journal=Zhonghua Yi Xue Za Zhi (Taipei) |volume=65 |issue=2 |pages=49–54 |year=2002 |pmid=12014357 |doi= |url=}}</ref><ref name="SzmuklerYoung1990">{{cite journal|last1=Szmukler|first1=G. I.|last2=Young|first2=G. P.|last3=Lichtenstein|first3=M.|last4=Andrews|first4=J. T.|title=A serial study of gastric emptying in anorexia nervosa and bulimia|journal=Australian and New Zealand Journal of Medicine|volume=20|issue=3|year=1990|pages=220–225|issn=00048291|doi=10.1111/j.1445-5994.1990.tb01023.x}}</ref><ref name="pmid12827003">{{cite journal |vauthors=Diamanti A, Bracci F, Gambarara M, Ciofetta GC, Sabbi T, Ponticelli A, Montecchi F, Marinucci S, Bianco G, Castro M |title=Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders |journal=J. Pediatr. Gastroenterol. Nutr. |volume=37 |issue=1 |pages=35–41 |year=2003 |pmid=12827003 |doi= |url=}}</ref><ref name="pmid981449">{{cite journal |vauthors=Ferholt J, Provence S |title=Diagnosis and treatment of an infant with psychophysiological vomiting |journal=Psychoanal Study Child |volume=31 |issue= |pages=439–59 |year=1976 |pmid=981449 |doi= |url=}}</ref><ref name="pmid17914944">{{cite journal |vauthors=Lee H, Rhee PL, Park EH, Kim JH, Son HJ, Kim JJ, Rhee JC |title=Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study |journal=J. Gastroenterol. Hepatol. |volume=22 |issue=11 |pages=1741–7 |year=2007 |pmid=17914944 |doi=10.1111/j.1440-1746.2006.04617.x |url=}}</ref><ref name="pmid9635600">{{cite journal |vauthors=Koskenpato J, Kairemo K, Korppi-Tommola T, Färkkilä M |title=Role of gastric emptying in functional dyspepsia: a scintigraphic study of 94 subjects |journal=Dig. Dis. Sci. |volume=43 |issue=6 |pages=1154–8 |year=1998 |pmid=9635600 |doi= |url=}}</ref><ref name="pmid7658213">{{cite journal |vauthors=Urbain JL, Vekemans MC, Parkman H, Van Cauteren J, Mayeur SM, Van den Maegdenbergh V, Charkes ND, Fisher RS, Malmud LS, De Roo M |title=Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia |journal=J. Nucl. Med. |volume=36 |issue=9 |pages=1579–86 |year=1995 |pmid=7658213 |doi= |url=}}</ref><ref name="pmid20723071">{{cite journal |vauthors=Hejazi RA, Lavenbarg TH, McCallum RW |title=Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome |journal=Neurogastroenterol. Motil. |volume=22 |issue=12 |pages=1298–302, e338 |year=2010 |pmid=20723071 |doi=10.1111/j.1365-2982.2010.01584.x |url=}}</ref><ref name="urlGastric outlet obstruction - an overview | ScienceDirect Topics">{{cite web |url=https://www.sciencedirect.com/topics/veterinary-science-and-veterinary-medicine/gastric-outlet-obstruction |title=Gastric outlet obstruction - an overview &#124; ScienceDirect Topics |format= |work= |accessdate=}}</ref><ref name="pmid6370777">{{cite journal |vauthors=Minami H, McCallum RW |title=The physiology and pathophysiology of gastric emptying in humans |journal=Gastroenterology |volume=86 |issue=6 |pages=1592–610 |year=1984 |pmid=6370777 |doi= |url=}}</ref><ref name="pmid2431640">{{cite journal |vauthors=Humphries LL, Adams LJ, Eckfeldt JH, Levitt MD, McClain CJ |title=Hyperamylasemia in patients with eating disorders |journal=Ann. Intern. Med. |volume=106 |issue=1 |pages=50–2 |year=1987 |pmid=2431640 |doi= |url=}}</ref><ref name="pmid2480214">{{cite journal |vauthors=Hempen I, Lehnert P, Fichter M, Teufel J |title=[Hyperamylasemia in anorexia nervosa and bulimia nervosa. Indication of a pancreatic disease?] |language=German |journal=Dtsch. Med. Wochenschr. |volume=114 |issue=49 |pages=1913–6 |year=1989 |pmid=2480214 |doi=10.1055/s-2008-1066848 |url=}}</ref><ref name="pmid19204432">{{cite journal |vauthors=Okada R, Okada A, Okada T, Okada T, Hamajima N |title=Elevated serum lipase levels in patients with dyspepsia of unknown cause in general practice |journal=Med Princ Pract |volume=18 |issue=2 |pages=130–6 |year=2009 |pmid=19204432 |doi=10.1159/000189811 |url=}}</ref><ref name="pmid23198276">{{cite journal |vauthors=Sansone RA, Sansone LA |title=Hoarseness: a sign of self-induced vomiting? |journal=Innov Clin Neurosci |volume=9 |issue=10 |pages=37–41 |year=2012 |pmid=23198276 |pmc=3508961 |doi= |url=}}</ref><ref name="pmid15972301">{{cite journal |vauthors=Tack J, Caenepeel P, Arts J, Lee KJ, Sifrim D, Janssens J |title=Prevalence of acid reflux in functional dyspepsia and its association with symptom profile |journal=Gut |volume=54 |issue=10 |pages=1370–6 |year=2005 |pmid=15972301 |pmc=1774686 |doi=10.1136/gut.2004.053355 |url=}}</ref><ref name="urlgut.bmj.com">{{cite web |url=http://gut.bmj.com/content/gutjnl/early/2005/06/21/gut.2004.053355.full.pdf |title=gut.bmj.com |format= |work= |accessdate=}}</ref><ref name="pmid10490048">{{cite journal |vauthors=Boles RG, Williams JC |title=Mitochondrial disease and cyclic vomiting syndrome |journal=Dig. Dis. Sci. |volume=44 |issue=8 Suppl |pages=103S–107S |year=1999 |pmid=10490048 |doi= |url=}}</ref><ref name="pmid24112485">{{cite journal |vauthors=Ranasinghe WK, Smith M |title=Gastric outlet obstruction with an elevated serum pancreatic lipase secondary to an infraumbilical hernia |journal=Ann R Coll Surg Engl |volume=95 |issue=7 |pages=122–4 |year=2013 |pmid=24112485 |doi=10.1308/003588413X13629960047795 |url=}}</ref><ref name="UiShibusawa2015">{{cite journal|last1=Ui|first1=Takashi|last2=Shibusawa|first2=Hiroyuki|last3=Tsukui|first3=Hidenori|last4=Sakuma|first4=Kazuya|last5=Takahashi|first5=Shuhei|last6=Lefor|first6=Alan K.|last7=Hosoya|first7=Yoshinori|last8=Sata|first8=Naohiro|last9=Yasuda|first9=Yoshikazu|title=Pretreatment of gastric outlet obstruction with pancrelipase: Report of a case|journal=International Journal of Surgery Case Reports|volume=12|year=2015|pages=87–89|issn=22102612|doi=10.1016/j.ijscr.2015.05.023}}</ref>
 
<small><small>
{| class="wikitable"
{| class="wikitable"
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disorder
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disorder
Line 14: Line 14:
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory findings
! colspan="5" align="center" style="background:#4479BA; color: #FFFFFF;" + |Laboratory findings
|-
|-
|
!
|'''Chronic nausea'''
|'''Chronic nausea'''
|'''Vomiting'''
|'''Vomiting'''
Line 33: Line 33:
|'''Ambulatory esophageal pH and impedance testing'''
|'''Ambulatory esophageal pH and impedance testing'''
|-
|-
|'''Gastroparesis'''
!'''Gastroparesis'''
|✔
|✔
|✔ (within 1 hour of eating)
|✔ (within 1 hour of eating)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|✔
|✔
|
|✔
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 47: Line 47:
|↓
|↓
|
|
* [[Anemia]]
|✔
|✔
|
|
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** Grade 4 (very severe), > 50% retention at 4 h
** Grade 4 (very severe), > 50% retention at 4 h
|
|
* '''Impedance testing (antroduodenal manometery):''' Loss of normal fasting MMC’s and reduced postprandial antral contractions and, in some cases pylorospasm
* '''Impedance testing (antroduodenal manometery):''' Loss of normal fasting migratory motor complexes (MMCs) and reduced postprandial [[Antrum|antral]] contractions and, in some cases pylorospasm
|-
|-
|'''Anorexia nervosa'''
!'''[[Anorexia nervosa]]'''
|✔
|✔
|✔
|✔
|✔
|✔
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|✔
|✔
|✔
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 72: Line 73:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|↓
|↓
|Leukocytosis, anemia
|
* [[Leukocytosis]], [[anemia]]
|✔
|✔
|
|
*
*Increased
|
|
* Gastric emptying may be delayed but may become normal as feeding recommences (short lived)
* [[Delayed gastric emptying|Gastric emptying may be delayed]] but may become normal as feeding recommences (short lived)
|
|
* '''Esophageal pH:''' May be decreased if patient develops [[gastroesophageal reflux disease]]
|-
|-
|'''Bulimia nervosa'''
!'''[[Bulimia nervosa]]'''
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|
|✔
|✔
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 93: Line 96:
|✔
|✔
|Normal
|Normal
|Leukocytosis, anemia
|
* [[Leukocytosis]], [[anemia]]
|✔
|✔
|
|
* Increased
|
|
* Gastric emptying delayed for a longer duration as compared to anorexia nervosa
* [[Delayed gastric emptying|Gastric emptying delayed]] for a longer duration as compared to [[anorexia nervosa]]
|
|
* '''Esophageal pH:''' May be decreased if patient develops [[gastroesophageal reflux disease]]
|-
|-
|'''Rumination syndrome'''
!'''[[Rumination syndrome]]'''
|✔
|✔
|✔ (Regurgitation more common- within minutes of meal intake)
|✔ ([[Regurgitation]] more common- within minutes of meal intake)
|✔
|✔
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 113: Line 119:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|↓
|↓
|Normal
|
* Normal
|✔
|✔
|
|
* Normal
|
|
* Delayed gastric emptying
* [[Delayed gastric emptying]]
|
|
* '''Esophageal pH:''' Fall in esophageal pH immediately after reguritation (occurs while patient is awake and erect; this is in contrast to GERD, where reflux occurs diurnally and supine position)
* '''Esophageal pH:''' Fall in [[esophageal]] pH immediately after reguritation (occurs while patient is awake and erect; this is in contrast to [[Gastroesophageal reflux disease|GERD]], where [[Gastroesophageal reflux disease|reflux]] occurs diurnally and [[supine]] position)


* '''Impedance testing:'''Increased intra-abdominal pressure leading to regurgitation of gastric contents (Tall R waves)
* '''Impedance testing:'''Increased intra-[[abdominal]] pressure leading to [[regurgitation]] of [[gastric]] contents (Tall R waves)
|-
|-
|'''Functional dyspepsia'''
!'''[[Functional dyspepsia]]'''
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 136: Line 144:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Normal
|Normal
|Normal
|
* Normal
|✔
|✔
|
|
* Increased (especially [[lipase]])
|
|
* [[Delayed gastric emptying]]
|
|
* '''Esophageal pH:''' May be decreased if patient develops [[Reflux esophagitis|reflux]]
|-
|-
|'''Cyclic vomiting syndrome'''
!'''[[Cyclic vomiting syndrome]]'''
|✔
|✔
|✔
|✔
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|✔
|✔
|
|✔
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 155: Line 167:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|↓
|↓
|Leukocytosis, anemia
|
* [[Leukocytosis]], [[anemia]]
|✔
|✔
|
|
* Increased (alongwith increased [[lactic acid]] - in cases of concomitant [[mitochondrial disease]])
|
|
* Rapid or normal
|
|
* '''Esophageal pH:''' Decreased
|-
|-
|'''Pancreatitis'''
!'''[[Pancreatitis]]'''
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|✔
|
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
Line 174: Line 190:
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|Normal
|Normal
|Leukocytosis
|
* [[Leukocytosis]]
|✔
|✔
|
|
* Increased
|
|
* Not indicated
|
|
* '''Esophageal pH:''' Normal
|-
|-
|'''Gastric outlet obstruction'''
!'''[[Gastric outlet obstruction]]'''
|✔
|✔
|✔ (within 1 hour of eating)
|✔ (within 1 hour of eating)
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|<nowiki>-</nowiki>
|
|<nowiki>-</nowiki>
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|Leukocytosis
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* [[Leukocytosis]]
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|✔
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* Increased (in cases of [[pancreatic]] disease)
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* [[Delayed gastric emptying]]
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* '''Esophageal pH:''' Increased
* '''Esophageal manometery:'''    High manoraetric score
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*[[Celiac disease]]
*[[Diabetic neuropathy]]
*[[Pancreatitis]]
*Diabetic diarrhea
*Gall bladder disease <ref>http://www.wrongdiagnosis.com/g/gastroparesis/misdiag.htm </ref>


==References==
==References==

Latest revision as of 21:21, 8 February 2019

https://www.wikidoc.org/index.php/Gastroparesis
https://www.wikidoc.org/index.php/Gastroparesis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Gastroparesis should be differentiated from other diseases that cause chronic nausea and vomiting. The differentials include psychiatric illnesses, rumination syndrome, functional dyspepsia and cyclic vomiting syndrome.

Differentiating Gastroparesis from other Diseases

Gastroparesis should be differentiated from other diseases that cause chronic nausea and vomiting. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]

Disorder Clinical features Laboratory findings
Chronic nausea Vomiting Diarrhea Retching Lethargy Social withdrawal Photophobia Epigastric pain/burning Lanugo hair Hypogonadism Russel's sign Body mass index (normal range: 18.5 to 24.9) Complete blood count (CBC) Electrolyte imabalance Lipase and amylase levels Gastric scintigraphy Ambulatory esophageal pH and impedance testing
Gastroparesis ✔ ✔ (within 1 hour of eating) - ✔ ✔ - - ✔ - - - ↓ ✔
  • Normal (maybe elevated if chronic renal failure is the cause of gastroparesis- usually less than threefold)
  • Periodic measurement of radiolabeled solid meal:  
    • Grade 1 (mild), 11%-20% retention at 4 h
    • Grade 2 (moderate), 21%-35% retention at 4 h
    • Grade 3 (severe), 36%-50% retention at 4 h
    • Grade 4 (very severe), > 50% retention at 4 h
  • Impedance testing (antroduodenal manometery): Loss of normal fasting migratory motor complexes (MMCs) and reduced postprandial antral contractions and, in some cases pylorospasm
Anorexia nervosa ✔ ✔ ✔ - ✔ ✔ - - ✔ ✔ - ↓ ✔
  • Increased
Bulimia nervosa ✔ ✔ ✔ ✔ ✔ ✔ - - - ✔ ✔ Normal ✔
  • Increased
Rumination syndrome ✔ ✔ (Regurgitation more common- within minutes of meal intake) ✔ - ✔ ✔ ✔ ✔ - - - ↓
  • Normal
 ✔
  • Normal
  • Esophageal pH: Fall in esophageal pH immediately after reguritation (occurs while patient is awake and erect; this is in contrast to GERD, where reflux occurs diurnally and supine position)
Functional dyspepsia ✔ ✔ ✔ ✔ - - - - - - - Normal
  • Normal
 ✔
  • Esophageal pH: May be decreased if patient develops reflux
Cyclic vomiting syndrome ✔ ✔ - ✔ ✔ - - - - - - ↓ ✔
  • Rapid or normal
  • Esophageal pH: Decreased
Pancreatitis ✔ ✔ ✔ ✔ ✔ - - ✔ - - - Normal ✔
  • Increased
  • Not indicated
  • Esophageal pH: Normal
Gastric outlet obstruction ✔ ✔ (within 1 hour of eating) - - - - - ✔ - - - ↓ ✔
  • Esophageal pH: Increased
  • Esophageal manometery:   High manoraetric score

References

  1. ↑ Parkman HP (2015). "Idiopathic gastroparesis". Gastroenterol. Clin. North Am. 44 (1): 59–68. doi:10.1016/j.gtc.2014.11.015. PMC 4324534. PMID 25667023.
  2. ↑ Werlin SL, Fish DL (2006). "The spectrum of valproic acid-associated pancreatitis". Pediatrics. 118 (4): 1660–3. doi:10.1542/peds.2006-1182. PMID 17015559.
  3. ↑ Noddin L, Callahan M, Lacy BE (2005). "Irritable bowel syndrome and functional dyspepsia: different diseases or a single disorder with different manifestations?". MedGenMed. 7 (3): 17. PMC 1681633. PMID 16369243.
  4. ↑ Gupta R, Kalla M, Gupta JB (2012). "Adult rumination syndrome: Differentiation from psychogenic intractable vomiting". Indian J Psychiatry. 54 (3): 283–5. doi:10.4103/0019-5545.102434. PMC 3512372. PMID 23226859.
  5. ↑ Sağlam F, Sivrikoz E, Alemdar A, Kamalı S, Arslan U, Güven H (2015). "Bouveret syndrome: A fatal diagnostic dilemma of gastric outlet obstruction". Ulus Travma Acil Cerrahi Derg. 21 (2): 157–9. PMID 25904280.
  6. ↑ Talley NJ (2011). "Rumination syndrome". Gastroenterol Hepatol (N Y). 7 (2): 117–8. PMC 3061016. PMID 21475419.
  7. ↑ Tutuian R, Castell DO (2004). "Rumination documented by using combined multichannel intraluminal impedance and manometry". Clin. Gastroenterol. Hepatol. 2 (4): 340–3. PMID 15067630.
  8. ↑ Kessing BF, Smout AJ, Bredenoord AJ (2014). "Current diagnosis and management of the rumination syndrome". J. Clin. Gastroenterol. 48 (6): 478–83. doi:10.1097/MCG.0000000000000142. PMID 24921208.
  9. ↑ Parkman HP (2009). "Assessment of gastric emptying and small-bowel motility: scintigraphy, breath tests, manometry, and SmartPill". Gastrointest. Endosc. Clin. N. Am. 19 (1): 49–55, vi. doi:10.1016/j.giec.2008.12.003. PMID 19232280.
  10. ↑ Waseem S, Moshiree B, Draganov PV (2009). "Gastroparesis: current diagnostic challenges and management considerations". World J. Gastroenterol. 15 (1): 25–37. PMC 2653292. PMID 19115465.
  11. ↑ Mearin F, Camilleri M, Malagelada JR (1986). "Pyloric dysfunction in diabetics with recurrent nausea and vomiting". Gastroenterology. 90 (6): 1919–25. PMID 3699409.
  12. ↑ Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, McCallum RW, Nowak T, Nusynowitz ML, Parkman HP, Shreve P, Szarka LA, Snape WJ, Ziessman HA (2008). "Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine". Am. J. Gastroenterol. 103 (3): 753–63. doi:10.1111/j.1572-0241.2007.01636.x. PMID 18028513.
  13. ↑ Jiang CF, Ng KW, Tan SW, Wu CS, Chen HC, Liang CT, Chen YH (2002). "Serum level of amylase and lipase in various stages of chronic renal insufficiency". Zhonghua Yi Xue Za Zhi (Taipei). 65 (2): 49–54. PMID 12014357.
  14. ↑ Szmukler, G. I.; Young, G. P.; Lichtenstein, M.; Andrews, J. T. (1990). "A serial study of gastric emptying in anorexia nervosa and bulimia". Australian and New Zealand Journal of Medicine. 20 (3): 220–225. doi:10.1111/j.1445-5994.1990.tb01023.x. ISSN 0004-8291.
  15. ↑ Diamanti A, Bracci F, Gambarara M, Ciofetta GC, Sabbi T, Ponticelli A, Montecchi F, Marinucci S, Bianco G, Castro M (2003). "Gastric electric activity assessed by electrogastrography and gastric emptying scintigraphy in adolescents with eating disorders". J. Pediatr. Gastroenterol. Nutr. 37 (1): 35–41. PMID 12827003.
  16. ↑ Ferholt J, Provence S (1976). "Diagnosis and treatment of an infant with psychophysiological vomiting". Psychoanal Study Child. 31: 439–59. PMID 981449.
  17. ↑ Lee H, Rhee PL, Park EH, Kim JH, Son HJ, Kim JJ, Rhee JC (2007). "Clinical outcome of rumination syndrome in adults without psychiatric illness: a prospective study". J. Gastroenterol. Hepatol. 22 (11): 1741–7. doi:10.1111/j.1440-1746.2006.04617.x. PMID 17914944.
  18. ↑ Koskenpato J, Kairemo K, Korppi-Tommola T, Färkkilä M (1998). "Role of gastric emptying in functional dyspepsia: a scintigraphic study of 94 subjects". Dig. Dis. Sci. 43 (6): 1154–8. PMID 9635600.
  19. ↑ Urbain JL, Vekemans MC, Parkman H, Van Cauteren J, Mayeur SM, Van den Maegdenbergh V, Charkes ND, Fisher RS, Malmud LS, De Roo M (1995). "Dynamic antral scintigraphy to characterize gastric antral motility in functional dyspepsia". J. Nucl. Med. 36 (9): 1579–86. PMID 7658213.
  20. ↑ Hejazi RA, Lavenbarg TH, McCallum RW (2010). "Spectrum of gastric emptying patterns in adult patients with cyclic vomiting syndrome". Neurogastroenterol. Motil. 22 (12): 1298–302, e338. doi:10.1111/j.1365-2982.2010.01584.x. PMID 20723071.
  21. ↑ "Gastric outlet obstruction - an overview | ScienceDirect Topics".
  22. ↑ Minami H, McCallum RW (1984). "The physiology and pathophysiology of gastric emptying in humans". Gastroenterology. 86 (6): 1592–610. PMID 6370777.
  23. ↑ Humphries LL, Adams LJ, Eckfeldt JH, Levitt MD, McClain CJ (1987). "Hyperamylasemia in patients with eating disorders". Ann. Intern. Med. 106 (1): 50–2. PMID 2431640.
  24. ↑ Hempen I, Lehnert P, Fichter M, Teufel J (1989). "[Hyperamylasemia in anorexia nervosa and bulimia nervosa. Indication of a pancreatic disease?]". Dtsch. Med. Wochenschr. (in German). 114 (49): 1913–6. doi:10.1055/s-2008-1066848. PMID 2480214.
  25. ↑ Okada R, Okada A, Okada T, Okada T, Hamajima N (2009). "Elevated serum lipase levels in patients with dyspepsia of unknown cause in general practice". Med Princ Pract. 18 (2): 130–6. doi:10.1159/000189811. PMID 19204432.
  26. ↑ Sansone RA, Sansone LA (2012). "Hoarseness: a sign of self-induced vomiting?". Innov Clin Neurosci. 9 (10): 37–41. PMC 3508961. PMID 23198276.
  27. ↑ Tack J, Caenepeel P, Arts J, Lee KJ, Sifrim D, Janssens J (2005). "Prevalence of acid reflux in functional dyspepsia and its association with symptom profile". Gut. 54 (10): 1370–6. doi:10.1136/gut.2004.053355. PMC 1774686. PMID 15972301.
  28. ↑ "gut.bmj.com" (PDF).
  29. ↑ Boles RG, Williams JC (1999). "Mitochondrial disease and cyclic vomiting syndrome". Dig. Dis. Sci. 44 (8 Suppl): 103S–107S. PMID 10490048.
  30. ↑ Ranasinghe WK, Smith M (2013). "Gastric outlet obstruction with an elevated serum pancreatic lipase secondary to an infraumbilical hernia". Ann R Coll Surg Engl. 95 (7): 122–4. doi:10.1308/003588413X13629960047795. PMID 24112485.
  31. ↑ Ui, Takashi; Shibusawa, Hiroyuki; Tsukui, Hidenori; Sakuma, Kazuya; Takahashi, Shuhei; Lefor, Alan K.; Hosoya, Yoshinori; Sata, Naohiro; Yasuda, Yoshikazu (2015). "Pretreatment of gastric outlet obstruction with pancrelipase: Report of a case". International Journal of Surgery Case Reports. 12: 87–89. doi:10.1016/j.ijscr.2015.05.023. ISSN 2210-2612.

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