PATHOPHYSIOLOGY
🤢Nausea: associated with fMRI changes
🧠⬇️ in network connectivity in the right insula network and the bilateral insula network
🤢Nausea: associated with fMRI changes
🧠⬇️ in network connectivity in the right insula network and the bilateral insula network
😖Abdominal pain
♦️present in 90%
♦️female > male
♦️associated with anxiety, depression, somatization
♦️does NOT correlate with degree of gastric emptying impairment
♦️present in 90%
♦️female > male
♦️associated with anxiety, depression, somatization
♦️does NOT correlate with degree of gastric emptying impairment
🧠Abnormal autonomic nervous system functioning: altered balance of sympathetic and parasympathetic innervation to the stomach
🔶Parasympathetic dysfunction is associated with more severe symptoms and delayed gastric emptying
🔥 Inflammation of enteric nerves in stomach
🔶Parasympathetic dysfunction is associated with more severe symptoms and delayed gastric emptying
🔥 Inflammation of enteric nerves in stomach
📣#Gastroparesis and functional dyspepsia should be considered part of the same spectrum of gastric neuromuscular disorders
Treatment (historical)
💊Metoclopramide (only FDA-approved therapy)
🧠 tardive dyskinesia risk: 0.1% per 1000 patient years
💉BoTox to pylorus: no better than placebo, but ongoing research
🔌Gastric electrical stimulation (questionable efficacy, may help nausea/vomiting)
💊Metoclopramide (only FDA-approved therapy)
🧠 tardive dyskinesia risk: 0.1% per 1000 patient years
💉BoTox to pylorus: no better than placebo, but ongoing research
🔌Gastric electrical stimulation (questionable efficacy, may help nausea/vomiting)
Newer treatments
💊5-Hydroxytryptamine 4 (5-HT4) agonists: prucalopride, felcisetrag
💊Neurokinin-1 receptor (N1KR) antagonists: aprepitant, tradipitant
🧠Vagal nerve stimulation
🔪gastric peroral endoscopic myotomy (G-POEM)
💊5-Hydroxytryptamine 4 (5-HT4) agonists: prucalopride, felcisetrag
💊Neurokinin-1 receptor (N1KR) antagonists: aprepitant, tradipitant
🧠Vagal nerve stimulation
🔪gastric peroral endoscopic myotomy (G-POEM)
A note on #diet
Some benefit from ⬇️ fats; consuming smaller, more frequent meals, and avoiding excess fiber
⚠️Watch out for ARFID
55% of #gastroparesis patients may have eating disorder
🟢ARFID most common
🔵anorexia nervosa also prevalent
Some benefit from ⬇️ fats; consuming smaller, more frequent meals, and avoiding excess fiber
⚠️Watch out for ARFID
55% of #gastroparesis patients may have eating disorder
🟢ARFID most common
🔵anorexia nervosa also prevalent
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