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]

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	Endoscopic findings	Gastric scintigraphy	Ambulatory esophageal pH and impedance testing
Gastroparesis	✔	✔ (within 1 hour of eating)	-	✔		-	-	✔	-	-	-	↓		✔			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	✔
Bulimia nervosa	✔	✔	✔	✔		✔	-	-	-	✔	✔	Normal	Leukocytosis, anemia	✔
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	✔

Celiac disease
Diabetic neuropathy
Pancreatitis
Diabetic diarrhea
Gall bladder disease ^[14]

References

↑ 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.
↑ 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.
↑ 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.
↑ 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.
↑ "Body weight in bulimia nervosa | SpringerLink".
↑ 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.
↑ Talley NJ (2011). "Rumination syndrome". Gastroenterol Hepatol (N Y). 7 (2): 117–8. PMC 3061016. PMID 21475419.
↑ Tutuian R, Castell DO (2004). "Rumination documented by using combined multichannel intraluminal impedance and manometry". Clin. Gastroenterol. Hepatol. 2 (4): 340–3. PMID 15067630.
↑ 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.
↑ 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.
↑ 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.
↑ Mearin F, Camilleri M, Malagelada JR (1986). "Pyloric dysfunction in diabetics with recurrent nausea and vomiting". Gastroenterology. 90 (6): 1919–25. PMID 3699409.
↑ 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.
↑ http://www.wrongdiagnosis.com/g/gastroparesis/misdiag.htm

Template:WH Template:WS

[pmid25667023-1] 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.

[pmid17015559-2] 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.

[pmid16369243-3] 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.

[pmid23226859-4] 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.

[urlBody_weight_in_bulimia_nervosa_|_SpringerLink-5] "Body weight in bulimia nervosa | SpringerLink".

[pmid25904280-6] 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.

[pmid21475419-7] Talley NJ (2011). "Rumination syndrome". Gastroenterol Hepatol (N Y). 7 (2): 117–8. PMC 3061016. PMID 21475419.

[pmid15067630-8] Tutuian R, Castell DO (2004). "Rumination documented by using combined multichannel intraluminal impedance and manometry". Clin. Gastroenterol. Hepatol. 2 (4): 340–3. PMID 15067630.

[pmid24921208-9] 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.

[pmid19232280-10] 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.

[pmid19115465-11] 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.

[pmid3699409-12] Mearin F, Camilleri M, Malagelada JR (1986). "Pyloric dysfunction in diabetics with recurrent nausea and vomiting". Gastroenterology. 90 (6): 1919–25. PMID 3699409.

[pmid18028513-13] 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.

[14] ttp://www.wrongdiagnosis.com/g/gastroparesis/misdiag.htm

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Gastroparesis differential diagnosis

Overview

Differentiating Gastroparesis from other Diseases

References

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