Gastric Motility

Question 1

Gastroparesis

Answer 1

Impaired transit of food from the stomach to the duodenum that is not due to mechanical obstruction, purely motility issue

Question 2

Causes of gastroparesis

Answer 2

• Diabetic (autonomic neuropathy)
• Idiopathic (viruses etc)
• Post surgical
• Medication related

Question 3

Clinical manifestations of gastroparesis

Answer 3

Nausea, vomiting, early satiety, postprandial abdominal distension and pain

Question 4

Complications of gastroparesis

Answer 4

• Delayed emptying of solids and indigestible particles
• Rapid emptying of liquids (prox stomach can’t accommodate so the antroduodenal pressure is high)
• Bezoar formation: conglomeration of non-digestible food that doesn’t empty over time. Partially due to loss of MMC fasting mechanism
• Malnutrition/wt loss

Question 5

Gastoparesis treatment

Answer 5

• Dopamine antag
• Motilin agonists (erythromycin)
• Antiemetics
• Gastric electric stimulation
• Surgical jejunostomy and feeding tube placement

Question 6

Dumping symdrome

Answer 6

Can be early or late

• Early: rush of nut to small bowel causes release of vasoactive factors leading to nausea, flushing, diarrhea and syncope
• Late: rush of sugar to small bowel causes huge insulin release leading to hypoglycemia

Question 7

Non-ulcer/Functional dyspepsia

Answer 7

• upper GI tract disorder that cause post-prandial distress (fullness/early satiety)
• symptoms persist 3+ months
• Not sure why we get it, maybe abnormal motility or visceral hypersenitivity

Question 8

Treatment of functional dyspep

Answer 8

Meds: PPis, prokinetics, gastric compliance enhancers, visceral perception blockers
-psychological: reassurance, stress reduction, biofeedback, hypnotherapy