Delayed gastric emptying: whom to test, how to test, and what to do.

摘要: Gastroparesis, or delayed gastric emptying, is a common cause of chronic nausea and vomiting as seen in gastroenterology practice. Diabetic, postsurgical, idiopathic causes remain the three most forms gastroparesis. In addition to vomiting, symptoms gastroparesis may include early satiety, postprandial fullness, abdominal pain. Physiologic changes that explain patients with gastroparesis, impaired fundic accommodation, antral hypomotility, dysrhythmias, pylorospasm, perhaps visceral hypersensitivity. Diagnosis best determined using radioisotope-labeled solid meal scintigraphic imaging for at least 2 hours, preferably 4 postprandially. Most commonly, 99mTc sulfur colloid-labeled egg sandwich 0, 1, 2, hours used. Extension emptying test improves accuracy test, but unfortunately, this not commonly performed many centers. Emptying liquids remains normal until late stages less useful. The aims treatment should be control maintain adequate nutrition hydration. Patients advised eat small meals limit their intake fat fiber. Additional dietary recommendations increasing caloric form liquids. For diabetic patients, blood glucose levels important, symptom exacerbation frequently associated poor glycemic control. Specific often begins metoclopramide, 10 mg, up four times daily, after discussion possible side effects patient. An antiemetic agent, such prochlorperazine, 5 mg orally 25 by suppository, can added on an as-needed basis every 6 nausea. If these medications are effective, if develop, dissolving ondansetron, 8 12 tried basis. regimen unsuccessful, then alternative prokinetic agents—erythromycin, 125 tegaserod, prior meals—can tried. cases refractory treatments, referral center US Food Drug Administration permission use domperidone considered. Alternatively, modulators low-dose tricyclic antidepressants reduce symptoms, do improve emptying. whom all medical therapy fails, other options experienced centers injection botulinum toxin into pylorus, placement feeding jejunostomy, and/or electrical stimulator.