GASTROENTEROLOGY ARTICLE OF THE WEEK
May 27, 2010
Reddymasu SC, Sarosiek I, McCallum RW. Severe gastroparesis: medical therapy or electrical stimulation. Clinical Gastroenterol Hepatol 2010;8:117-124.
1. Clues that point to gastroparesis include:
a. Acute recurrent episodes with symptom-free periods
b. Vomiting of undigested food several hours after a meal
c. Nausea, posprandrial distress symptoms soon after eating, with vomiting delayed by 1 to 4 hours
d. Regurgitation of undigested food within 20 minutes of ingestion
2. Manometric features of diabetic gastroparesis include
a. increased frequency of antral contractions
b. pylorospasm
c. antroduodenal incoordiantion
d. increased gastric tone
True or False
3. Subcutaneous metoclopramide at a dose of 10mg up to every 6 hours may increase bioavailability
4. Botulinum toxin injections around the pyloric area may be effective in patients who are refractory to metoclopramide therapy
5. Scintigraphy for diagnosing gastroparesis should be done using a standardized radiolabeled meal of egg-beaters, and the study should last 4 hours.
6. After gastric stimulation device placement, onset of improvement usually takes 6-8 months
7. Delayed gastric emptying may be caused or aggravated by PPI
8. Patients with gastroparesis should eat frequent small meals with a high fiber content
9. Scopolamine patches and tricyclic antidepressant may be used as adjuncts for symptomatic improvement
10. Patients with idiopathic gastroparesis are least likely to respond to electric stimulation therapy
11. Liquid erythromycin 125mg 3 times per day with drug holidays may help manage patients with gastroparesis
12. In most cases, improvement of symptoms after GES implant correlate with improved gastric emptying