Gastroparesis

Gastroparesis is a condition characterized by symptoms resulting from impaired emptying of intraluminal gastric contents of the stomach into the duodenum in the absence of a mechanical obstruction.

The syndrome may be caused by diabetes, occur after gastric surgery, or be idiopathic. In diagnostic studies conducted by Goswami and colleagues (1997), patients with idiopathic gastroparesis were more likely to note difficulty emptying (70%), whereas those with diabetic gastroparesis were more likely to have urinary frequency (71%).

The authors postulated an association between idiopathic gastroparesis and bladder dysfunction and proposed a common autonomic neuropathic syndrome may account for the bladder dysfunction in both the idiopathic and the diabetic forms of this syndrome.

Pathophysiology

Any systemic disease or condition that leads to neuromuscular dysfunction of the gastrointestinal tract may lead to gastroparesis. The most common causes in infants and children include prematurity, viral infections, drugs such as opioids and anticholinergics, metabolic disturbances such as hypokalemia, acidosis, and hypothyroidism, eosinophilic gastroenteropathy, cerebral palsy, diabetes mellitus, vagotomy, pseudo-obstruction, and muscular dystrophy.

Many patients have no apparent etiology and are diagnosed to have idiopathic gastroparesis. Postviral gastroparesis is a recently described entity in children, accounting for many forms of acquired gastroparesis. It follows a short viral illness, often rotavirus, and is associated with postprandial antral hypomotility.

Presentation

Nausea, vomiting, fullness, bloating, and early satiety are classically the predominant symptoms of gastroparesis. Some children with prolonged symptoms may have weight loss. The emesis characteristically occurs hours after eating, a differentiating feature from both GERD and rumination.

Diagnosis

Nuclear medicine scintiscan is the gold standard for the measurement of gastric emptying and can be used as a reliable screening test for abnormal gastric motility, although normal values for emptying of different meals at different ages are unknown.

A normal gastric emptying of a solid meal by definition rules out gastroparesis. Emptying of barium or liquid meals should not be relied upon for this diagnosis. In postviral gastroparesis, antroduodenal manometry demonstrates postprandial antral hypomotility with normal antral contractions during fasting.

Ultrasonography has been used to evaluate gastric emptying in young infants. The 13Coctanoic acid breath test is a newer, safe, nonradiologic test that has been used to measure liquid and solid gastric emptying.

Treatment

Postviral gastroparesis usually resolves within 6–24 months. In children with prolonged symptoms and associated weight loss, nutritional support with nasoduodenal and nasojejunal feeding tubes is required.

Various prokinetic medications such as cisapride, erythromycin, metoclopramide, and domperidone have been used to improve the gastric emptying. Erythromycin has proved to be the most effective gastrokinetic. In patients with neurological impairment such as cerebral palsy, surgical pyloroplasty or pyloromyotomy remains a therapeutic option. Transpyloric feeding can be considered for a short period of time before pursuing surgery.

related literatures:
    Adapted from: The Gastroesophageal Reflux in Infants and Children: Diagnosis, Medical .... Authored By Ciro Esposito, Philippe Montupet, Steven Rothenberg.