Gastroparesis differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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.

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]

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 MMC’s and reduced postprandial antral contractions and, in some cases pylorospasm
Anorexia nervosa ✔ ✔ ✔ - ✔ - - ✔ ✔ - ↓ Leukocytosis, anemia ✔
  • Gastric emptying may be delayed but may become normal as feeding recommences (short lived)
Bulimia nervosa ✔ ✔ ✔ ✔ ✔ - - - ✔ ✔ Normal Leukocytosis, anemia ✔
  • Gastric emptying delayed for a longer duration as compared to anorexia nervosa
Rumination syndrome ✔ ✔ (Regurgitation more common) ✔ - ✔ ✔ ✔ ✔ - - - ↓ Normal ✔
  • Esophageal pH: Fall in esophageal pH immediately after reguritation
  • Impedance testing:Increased intra-abdominal pressure leading to regurgitation of gastric contents (Tall R waves)
Functional dyspepsia ✔ ✔ ✔ ✔ - - - - - - Normal Normal ✔
Cyclic vomiting syndrome ✔ ✔ - ✔ - - - - - - ↓ Leukocytosis, anemia ✔
Pancreatitis ✔ ✔ ✔ ✔ - - ✔ - - - Normal Leukocytosis ✔
Gastric outlet obstruction ✔ ✔ (within 1 hour of eating) - - - - ✔ - - - ↓ Leukocytosis ✔

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. ↑ http://www.wrongdiagnosis.com/g/gastroparesis/misdiag.htm

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