Gastric emptying is a neurohormonally controlled process that occurs after gastric accommodation, in which get digestible solids are pulverized in the stomach into small particles and then emptied into the duodenum through coordinated astral contractions.
Gastric emptying is highly dependent on food characteristics, including volume, caloric density, and chemical composition.
Low calorie liquids are emptied from the stomach passively, whereas high calorie liquids, digestible solids, and indigestible solids require progressively more gastric effort.
When gastric emptying is delayed, the emptying of high fat foods and indigestible solids is affected first; retention of gastric contents correlates with symptoms such as nausea vomiting and abdominal pain.
Gastroparesis is diagnosed when the symptoms correlate with evidence of delayed gastric emptying on scintigraphy.
Delayed gastric emptying secondary to abnormal motility occurs without mechanical outlet obstruction.
Chronic condition with significant morbidity.
Most common in young and middle aged females.
Patients present with nausea, vomiting, early satiety, bloating, abdominal pain, anorexia and weight loss.
Gastric retention of more than 10% of a standard low-fat meal at 4 hours indicates the presence of delayed emptying.
36% of cases are idiopathic and 29% are related to autonomic dysfunction secondary to diabetes.
May affect as many as 50% of patients with long standing diabetes.
Prokinetic drugs may improve gastrointestinal symptoms.
Severe refractory cases may be benefited from surgery, tube feedings or gastric pacing.
Erythromycin increasingly used in the management of gastroparesis.
Erythromycin is a potent motilin agonist that induces phase III migrating motor complex contractions.
Erythromycin is a potent prokinetic that enhances gastric emptying in healthy volunteers, in patients with gastroparesis caused by diabetes or vagot- omy.
Erythromycin is effective both p.o. and intravenously.