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gastroparesis diagnosis and treatment

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Gastroparesis Diagnosis and Treatment
  • Bill Richards, MD FACS
  • Professor and Chair Surgery
  • University of South Alabama
  • College of Medicine
etiology of gastroparesis
Etiology of Gastroparesis
  • Diabetes-related
  • Metabolic hyper-glycemia, hypo-kalemia, hypermagnesemia
  • Hypo-pituitarism, hypo-adrenalism, hypo-thyroidism
  • Chronic renal failure
  • Portal hypertension
  • Intra-abdominal malignancy
  • Infectious: H. pylori., EBV
  • Rheumatological: Systemic sclerosis, SLE,
  • Myotonic dystrophies
  • Central Nervous System disorders (Parkinson’s disease, multiple sclerosis)
  • Peripheral Nervous System disorders (amyloid neuropathy, Guillain-Barre, primary dysautonomia)
  • Psychiatric disorders (anorexia nervosa, rumination syndrome)
surgery related etiology of gastroparesis
Surgery Related Etiology of Gastroparesis
  • Vagotomy,
  • Duodenectomy
  • Mechanical Obstruction Partial
drugs that delay gastric emptying
Drugs that delay Gastric Emptying
  • Alcohol
  • Aluminium hydroxide antacids
  • Atropine
  • beta-Agonists
  • Calcium channel blockers
  • Diphenhydramine
  • L-Dopa
  • Lithium
  • Ondansetron
  • Opiates
  • Phenothiazines
  • Tricyclic anti-depressants
anti emetic agents
Anti-emetic agents
  • Prochlorperazine Compazine
    • Tardive dyskinesia
  • Promethazine
  • 5-hydroxytryptamine receptor agonist (i.e. odansetron)
    • Reduce dose with hepatic disease
botulinum toxin a for the treatment of delayed gastric emptying am j gastro 103 416 423 2008
Botulinum Toxin A for the Treatment of Delayed Gastric EmptyingAm J Gastro 103; 416-423, 2008

Placebo and Botox improved symptoms and gastric emptying

prokinetic agents
Prokinetic agents
  • Metoclopramide (reglan)
    • Antral contractions
    • Extrapyramidal symptoms
  • Erythromycin
    • Motolin agonist
    • Induces phase III MMC
    • Cardiac arrhythmias
  • Domperidone.
    • Not marketed in US
  • Cisapride
    • cardiac arrhythmias FDA removed from use
slide13

Predictive Factors for Clinical Improvement with Enterra Gastric Electric Stimulation Treatment for Refractory Gastroparesis Dig Dis Sci (2008) 53:2072–2078

ileal brake
Ileal brake is most potent inhibitory feedback

Companion brakes work in absence of ileal brake

Ileal Brake
ileal brake1
Fats in ileum trigger release of Peptide YY

Peptide YY inhibits gastric emptying

Ileal Brake
resectional therapy
Resectional Therapy
  • Subtotal gastrectomy
  • Roux-en-Y reconstruction
  • Preop measurement of vitamin D, Thiamine,

B-12, folate, iron