Complications
Patients who do not respond to conventional doses of prokinetics or anti-emetics usually present to the emergency department and are admitted to hospital for intractable symptoms of nausea and vomiting, and resultant dehydration and electrolyte abnormalities. Optimising the dose of prokinetics and anti-emetics could be helpful, as is consultation with a gastroenterologist.
In patients who do not respond to conventional medical therapy, referral to a centre with expertise in implantation of gastric electrical stimulators is also recommended.[58][125]
Patients with gastroparesis who have severe nausea and vomiting are at risk of developing various nutritional deficiencies due to decreased oral intake.
Optimising the doses of prokinetics and anti-emetics, enteral nutrition through a jejunal feeding tube, and referral for evaluation for a gastric electrical stimulator are therapeutic considerations for patients who continue to do poorly.[81]
Patients with diabetic gastroparesis, especially those whose oral intake is unpredictable, can have wide fluctuations in blood sugars, making glycaemic control unpredictable.[81]
Regular follow-up by an endocrinologist is important to formulate an individualised insulin regimen for optimal glycaemic control, which could in turn help symptoms of gastroparesis.
Patients with uncontrolled vomiting due to gastroparesis can develop erosive oesophagitis due to repeated exposure of the oesophagus to the acidic gastric contents.
Symptoms include chest pain, heartburn, and, in some instances, coffee-ground emesis.
Better control of gastroparetic symptoms and instituting proton-pump inhibitor therapy are helpful in this scenario.
Patients with repeated emetic episodes could have a sudden rise in intra-abdominal pressure causing a mucosal tear near the gastro-oesophageal junction.
Bleeding from this tear causes painless upper gastrointestinal bleeding.
Monitoring haemoglobin and a diagnostic or therapeutic endoscopy are recommended in this scenario.
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