Gastroparesis: Less common causes (Part Five)

A number of other conditions can cause GP less frequently.  Parkinson disease is well known to cause GI motility issues, including GP.  In this group, the GI dysfunction is due to poor control of the smooth muscle in the GI tract.  Multiple sclerosis, muscular dystrophy, myopathy and having a stroke can negative impact gastric emptying.  50-75% of scleroderma patients with GI symptoms have delayed emptying.  29% of Sjogrens patients have GP.  GP is also sometimes present in polymyositis cases.

10.8% of GP cases are associated with some type of connective tissue disorder.  A clear connection to hypermobility type EDS is being elucidated.  Pseudoobstruction syndromes are sometimes comorbid with GP.  A significant number of patients affected by conditions that feature autonomic neuropathy have GP.

Some viral infections can cause acute GP, which generally resolves within a year.  Spinal cord injury, hypothyroidism, hyperparathyroidism, Addison’s disease, and regular use of opiates and/or anticholinergic medications can also contribute.

While the reason for this link is unknown, gastroparesis occurs disproportionately in patients who have had their gallbladders removed.  In many patients, the gastroparesis does not immediately follow gallbladder removal surgery – it can sometimes take years to present.  Prior gallbladder removal can worsen diabetic or idiopathic GP.  Gallbladder removal (cholecystectomy) is associated with several conditions that can be comorbid with gastroparesis, including chronic fatigue syndrome (CFS), fibromyalgia, depression and anxiety.  Severe upper abdominal pain and retching are cardinal GP symptoms in this population, with nausea and constipation less severe.

GP patients who previously had their gallbladders removed are frequently older women who are overweight despite not consuming enough calories.  Overweight people with GP are more likely to have severe bloating.  Significant bloating indicates poor response to management.  Medications that increase reuptake of norepinephrine, such as tricyclic antidepressants, can help manage bloating in some patients.

References:

Sarosiek, Irene, et al. Surgical approaches to treatment of gastroparesis: Gastric electrical stimulation, pyloroplasty, total gastrectomy and enteral feeding tubes.  Gastroenterol Clin N Am 44 (2015) 151-167.

Pasricha, Pankaj Jay, Parkman, Henry P. Gastroparesis: Definitions and Diagnosis. Gastroenterol Clin N Am 44 (2015) 1-7.

Parkman, H. P. Idiopathic Gastroparesis. Gastroenterol Clin N Am 44 (2015) 59-68.

Nguyen, Linda Anh, Snape Jr., William J. Clinical presentation and pathophysiology of gastroparesis.  Gastroenterol Clin N Am 44 (2015) 21-30.

Bharucha, Adil E. Epidemiology and natural history of gastroparesis. Gastroenterol Clin N Am 44 (2015) 9-19.

Camilleri, Michael, et al. Clinical guideline: Management of gastroparesis. Am J Gastroenterol 2013; 108: 18-37.

4 Responses

  1. Mary Ellingson August 29, 2015 / 6:48 pm

    I recieved this link from my sister-in-law. I found it very interesting. I had mr gallbladder removed in 1979 and have had nothing but problems ever since it seems everything I eat goes right thru me. I take 4Dyclycline a day I have never been able to cut back is there anything else I can do???????

    • Lisa Klimas August 29, 2015 / 10:26 pm

      It depends a lot on what symptoms you are having. You need to be evaluated in order to determine if you are having GI motility issues, such as gastroparesis. If you are, there are a number of medications that can be tried.

      • Mary Ellingson August 30, 2015 / 7:05 am

        I have had Coloniscopys and some kind of test where they put a camera down your throat and came up with nothing. I have been investigating myself thinking I could be Lactoce Intollerent. I was somewhat better when I discontinued Dairy. But if I eat Chinese Food Homeaid Meatloaf to name a few I don’t even get thru tge meal before running to the restroom

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