Gastroparesis: New Guidelines
Gastroparesis: New Guidelines
The gold standard for diagnosing gastroparesis is a test of solid-phase gastric emptying. If you are not able to do a 4-hour gastric emptying test, don't feel neglected, because I still can't get this in my own institution. Still, the recommendation is that solid-phase gastric emptying is the best diagnostic test, and extrapolations beyond that reduce sensitivity and specificity. Gastric emptying of less than 50% at 4 hours is concordant with the diagnosis of gastroparesis.
New diagnostic tests include a C breath test and a wireless motility capsule test, but the data on these tests are in need of validation before they can replace the diagnostic gold standards.
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The exclusion of other diagnoses is an area of concern. It is recommended that practitioners consider alternative diagnoses. In addition to diabetes and rheumatologic, endocrine, neurologic, and postsurgical diseases, others that should be considered in the differential include eating disorders such as anorexia and bulimia. Patients with these disorders may have gastric delay on testing. Another area is cyclic vomiting syndrome. I have also found coincidentally that many of these patients are taking cannabinoids, and they present with a cyclic vomiting type of presentation. When you take a history or get a urine drug screen, you might find that these patients are taking cannabinoids. These symptoms can overlap with those of gastroparesis and warrant further evaluation.
The Diagnosis of Gastroparesis
The gold standard for diagnosing gastroparesis is a test of solid-phase gastric emptying. If you are not able to do a 4-hour gastric emptying test, don't feel neglected, because I still can't get this in my own institution. Still, the recommendation is that solid-phase gastric emptying is the best diagnostic test, and extrapolations beyond that reduce sensitivity and specificity. Gastric emptying of less than 50% at 4 hours is concordant with the diagnosis of gastroparesis.
New diagnostic tests include a C breath test and a wireless motility capsule test, but the data on these tests are in need of validation before they can replace the diagnostic gold standards.
[ CLOSE WINDOW ]
(Enlarge Slide)
The exclusion of other diagnoses is an area of concern. It is recommended that practitioners consider alternative diagnoses. In addition to diabetes and rheumatologic, endocrine, neurologic, and postsurgical diseases, others that should be considered in the differential include eating disorders such as anorexia and bulimia. Patients with these disorders may have gastric delay on testing. Another area is cyclic vomiting syndrome. I have also found coincidentally that many of these patients are taking cannabinoids, and they present with a cyclic vomiting type of presentation. When you take a history or get a urine drug screen, you might find that these patients are taking cannabinoids. These symptoms can overlap with those of gastroparesis and warrant further evaluation.
