Take home points: August 2015

GP is a condition in which stomach contents do not move into the small intestine in an appropriate time frame without an obvious anatomical reason
GP patients can have severe symptoms, including nausea, vomiting, abdominal pain and bloating
GP can be episodic or chronic
The degree of gastric emptying delay does not impact symptom severity
GP may affect up to 2% of the population
GP is increasing over the last twenty years with no clear reason as to why
Cisapride is effective for treating GP but was removed from the market
GP symptoms are generic and make the cause hard to identify
Idiopathic GP has no clear cause and affects up to 1/3 of GP patients

Treating dehydration and electrolyte and nutritional deficiencies are key to initial GP management
64% of GP patients do not consume enough daily calories
Vitamins A, B6, C and K, iron, potassium and zinc are often deficient in GP patients
Small meals with low fat and fiber are recommended
Liquids or blended solids often empty normally from stomach
Feeding tubes may be placed if malnutrition is significant
Metoclopramide is approved for GP but use longer than twelve weeks carries risks like dystonia
Domperidone is not approved in US for GP but can be imported through a special FDA program for GP
Medications to increase gastric motility, like erythromycin, are often used
Medications for nausea and vomiting are common, such as ondansetron, scopolamine, draonabinol and tricyclic antidepressions
Nortriptyline and desipramine are tricyclics of choice as amitryptline can cause delayed gastric emptying
Opiates can induce GP so meds like gabapentin, tramadol, tapentadol, pregabalin and nortriptyline are preferred for abdominal pain
Botox injection into pyloric sphincter can increase gastric emptying but doesn’t always improve symptoms
Acupuncture and gastric pacemaker are also options

40% of patients with type I diabetes have delayed gastric emptying
20% of patients with type II diabetes have delayed gastric emptying
In 2004, 26.7% of GP patients had diabetes
Diabetic patients with GP are more likely to have nausa and vomiting as predominant symptoms
GP can hinder effective blood sugar management
High blood sugar is associated with GP and vagus nerve damage
Gastric electric stimulation (gastric pacemaker) works better when GP is caused by diabetes than GP from other causes
Effective GP management improves blood sugar management and A1C level

Surgery is a common trigger for GP
Surgeries that manipulate the stomach are more associated with GP, like gastrectomy, fundoplication or weight loss surgery
Gastric inflammation associated with surgery inhibits GI motility
7.2% of GP cases occur after gastrectomy or fundoplication
Nissen fundoplication is the most common cause of post-surgical GP
A follow up surgery after Nissen fundoplication can sometimes reverse GP
Surgeries that don’t manipulate the stomach can also cause GP, like removal of esophagus, lung transplant, and liver surgery

Parkinson disease, multiple sclerosis, muscular dystrophy, myopathy, scleroderma, Sjogrens, polymyositis and stroke can all cause GP.
10.8% of GP cases are associated with connective tissue disorder
Pseudo obstruction syndromes and autonomic neuropathy can occur concurrently with GP
Viral infections can cause acute GP that usually resolves within a year
Spinal cord injury, hypothyroidism, hyperparathyroidism, Addison’s disease and use of opiates or anticholinergics can contribute to GP
GP occurs disproportionately in people who have had their gallbladders removed
- Often, GP does not immediately follow gallbladder removal but can present months or years later
- Gallbladder removal is also associated with conditions that can occur with GP such as chronic fatigue syndrome, fibromyalgia, depression and anxiety
- GP patients who have had gallbladders removed are usually older women who are overweight despite not coming enough calories