Gastroparesis: Idiopathic gastroparesis (Part Seven)

Gastroparesis occurring in the absence of any known trigger, such as diabetes, surgery, medication or disease related onset, is classified as idiopathic gastroparesis.  In most series that include patients with multiple forms of gastroparesis, idiopathic gastroparesis (IGP) is the most common, affecting 35-67% of GP cases.  As with most forms of GP, IGP affects about three times more women than men, particularly young and middle-aged women.  IGP in particular affects young women who are overweight or obese.

In a study including 243 patients with IGP, 88% were female.  34% reported frequent nausea, 23% abdominal pain and 19% vomiting.  28% had severely delayed gastric emptying, here defined as more than 35% retention of contents four hours after consumption.  46% were overweight.  When compared to patients with diabetic GP, IGP patients more often reported feeling too full after eating and that their hunger was sated by smaller meals.  IGP patients demonstrated more severe gastric retention than type I diabetic GP patients.

Moderate/severe upper abdominal pain was found to be more frequent in IGP, and correlated with GP severity, decrease in quality of life, depression and anxiety.  Having pain as the predominant symptom causes quality of life impairment equivalent with nausea and vomiting.

Bloating is a common GP symptom.  Severe bloating was present in 41% of patients, and was more common in overweight female patients.  It also corresponded with severe nausea, fullness, distention, abdominal pain and notable bowel dysfunction.  Quality of life and other measures of wellbeing decrease as bloating becomes more severe.

Idiopathic GP is treated similarly to other types, but diagnosis may be delayed due to the lack of a known trigger.  Medications that have been reported as helpful but have not been studied in larger populations include sildenafil, paroxetine, cisapride, tegaserod, clonidine and buspirone.

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.

 

Gastroparesis: Part 1

Gastroparesis (GP) is a condition in which stomach contents are not emptied into the small intestine within an appropriate time period without an obvious anatomical explanation.  Gastroparesis patients are highly symptomatic, with approximately 90% reporting nausea, 84% vomiting, and abdominal pain, bloating, feeling unable to eat more after a small portion and feeling very “full” after even a small meal.  Some patients can manage their symptoms with dietary changes and medication, while others continue to be significantly symptomatic.

In some people, GP manifests episodically, with no symptoms for periods of time between flares.  In others, symptoms are chronic and perpetual.  Malnutrition, dehydration and weight loss can be severe in some cases.  Despite the primary functional feature of gastroparesis being the delayed emptying of the stomach, the degree to which gastric emptying is slowed correlates poorly with symptoms and severity of symptoms.

Gastroparesis affects at least 37.8 women/100000 persons and 9.6 men/100000 persons.  Once thought to be uncommon, it is now thought that gastroparesis may affect up to 2% of the population.  Hospital admissions for gastroparesis have increased dramatically in the last two decades, with a 158% increase between 1995 and 2004, with 138% of that increase occurring between 2000 and 2004.  There are several possible reasons for this phenomenon, including changes to criteria, better recognition and the withdrawal of cisapride from the market, a medication that alleviated some gastroparesis symptoms.

Gastroparesis is marked by generic gastrointestinal symptoms which can make it hard to identify unless the clinician is familiar with this condition.  Initially, it is often mistaken for functional dyspepsia.  For patients who have distinct episodes rather than continuous symptoms, patients are sometimes misdiagnosed with cyclic vomiting syndrome.

Gastroparesis can occur as a result of a number of diseases or circumstances.  Diabetes and surgery are the most commonly reported causes.  Idiopathic gastroparesis, in which no specific cause can be found, is often the most common in patient groups studied, with up to 1/3 of patients having this type.  Autonomic neuropathy, connective tissue diseases, autoimmune disease, thyroid disease can also cause gastroparesis, among many other conditions.

 

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.