History and exam
Key diagnostic factors
Other diagnostic factors
common
uncommon
succussion splash
Occasionally heard in patients.[58]
Risk factors
strong
diabetes mellitus
Gastroparesis is a recognized complication of diabetes mellitus, especially in patients with longstanding type 1 diabetes. Other autonomic disturbances are often present (e.g., postural hypotension).[47]
previous gastric and pancreatic surgery
Surgeries of the upper abdomen (gastric and pancreatic) are known to cause gastroparesis as a result of vagal nerve injury.[3]
female sex
About 80% of patients with gastroparesis are female.[20]
weak
achalasia
Achalasia has been associated with gastroparesis, but the exact mechanism by which it causes delayed gastric emptying is not known.[13]
atrophic gastritis
Delayed emptying of solids is observed in patients with atrophic gastritis with or without pernicious anemia.[16]
functional dyspepsia
It can be difficult to distinguish idiopathic gastroparesis from functional dyspepsia in some cases, leading some to speculate they are variants of the same disorder. As with idiopathic gastroparesis, some patients with functional dyspepsia present after an acute infection. Furthermore, approximately one-third of patients with functional dyspepsia exhibit delayed emptying.[16]
celiac disease
anorexia
Gastroparesis is known to occur in anorexia nervosa, but the exact mechanism is not clear.[17]
Parkinson disease
multiple sclerosis
scleroderma
amyloidosis
Gastroparesis occurs in patients with systemic amyloidosis; the delay in gastric emptying is due to deposition of amyloid in the gastric musculature.[24]
systemic lupus erythematosus
Gastroparesis is seen in patients with systemic lupus erythematosus (SLE), but it is rare. The exact pathophysiologic mechanism of gastroparesis in SLE is not currently understood.[20]
hypothyroidism
chronic renal insufficiency
acute viral infection
paraneoplastic syndrome (tumor-associated)
Occasionally, gastroparesis is the manifestation of paraneoplastic syndrome in patients with pancreatic cancer, breast cancer, small cell lung cancer, or cholangiocarcinoma.[32][33]
Delayed gastric emptying in paraneoplastic syndrome results from the destruction of myenteric plexus by autoantibodies that develop in this condition.
Demonstration of antineuronal nuclear antibody-1 or anti-hu antibody is supportive of the diagnosis of paraneoplastic syndrome-associated gastroparesis.
use of specific drugs
Opioids can cause gastroparesis.[48] The exact mechanism is not known, but it is thought that they delay gastric emptying by their activity on the mu and kappa opioid receptors.
Anticholinergic agents can cause delayed gastric emptying.[49] The exact mechanism is unknown, but it is thought that they block the part of gastric emptying that is cholinergic mediated. The delay in gastric emptying is usually mild.
Tricyclic antidepressants have anticholinergic activity, and therefore can also be a cause of gastroparesis.[48] The delay in gastric emptying is usually mild. They are occasionally used in patients with gastroparesis for refractory nausea.
Other drugs that can cause delayed gastric emptying include: calcium-channel blockers, clonidine, dopamine agonists, lithium, nicotine, progesterone, octreotide, proton-pump inhibitors, interferon alfa, levodopa, glucagon, and calcitonin.[9][50][51][52][53][54][55]
alcohol
Ethanol can produce delayed gastric emptying that is not dose-dependent. The delay seems to be greater with red wine than with beer.[34]
chronic mesenteric ischemia
Has been associated with gastroparesis.[31]
median arcuate ligament syndrome
The median arcuate ligament syndrome, an entity caused by compression of the celiac axis by a fibrous band, presents with postprandial pain, nausea, vomiting, weight loss, and delayed gastric emptying.[16]
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