Gastroparesis in Non-Diabetics: Associated Conditions and Possible Risk Factors

Abstract

BackgroundGastroparesis is a syndrome characterized by delayed gastric emptying in the absence of any mechanical cause. While often associated with diabetes mellitus, most cases of gastroparesis are idiopathic. The purpose of the present paper is to review the co-morbid conditions that most likely associate with non-diabetic gastroparesis.MethodsThe Healthcare Cost and Utilization Project: Nationwide Inpatient Sample (HCUP-NIS) data were used from the year 2013 - 2014 and the Apriori algorithm was run on this subset of patients to identify what co-morbid conditions are most likely associated with gastroparesis.ResultsNotable conditions that were found to be most closely linked with gastroparesis were: chronic pancreatitis, end stage renal disease, irritable bowel syndrome, systemic lupus erythematosus, fibromyalgia, and venous thromboembolism. Some of the implications of these findings are briefly discussed.ConclusionsGastroparesis is strongly associated with multiple medical conditions which may be potential targets for treatment.

Functional Emesis

“…It is frequently present in patients with diabetes, Parkinsonism and abdominal surgery affecting the vagus nerve. Rare causes include: mononucleosis, scleroderma, Ehlers-Danlos syndrome, chronic renal failure, hypochlorhydria, intestinal pseudoobstruction, eating disorders, mitochondrial disease, narcotic analgesic or anticholinergic medications, amyloidosis, heavy cigarette smoking, mesenteric ischemia and paraneoplastic syndrome [30][31][32][33][34].…”

“…The most common symptoms of IGP are represented by nausea (>90% of patients), vomiting (84% of patients), and early satiety (60% of patients). Rarely, postprandial fullness and upper abdominal pain appears, and weight loss, malnutrition, and dehydration appear only in severe cases [30][31][32]. In patients with mental disorders, such as depression or anxiety, higher anxiety/depression scores are correlated with the severity of the symptoms.…”

“…The dietary changes that can improve the symptomatology are: increasing the liquids ingestion rather than solids, consuming multiple low-fat small meals, and maintaining optimal glucose levels in diabetic patients. Male gender, gastrointestinal infections and the use of antidepressants, were proven to be predictors of symptom improvement by one study, and obesity, smoking, abdominal pain, gastroesophageal reflux disorder, severe depression were identified as predictors of no improvement [30][31][32][33].…”

“…Metoclopramide can cause extrapyramidal symptoms and should be administrated with caution to patients with anxiety or depression [36][37][38]. Furthermore, mirtazapine and other antidepressants may be an option by enhancing receptive relation and alleviating distress associated with gastroparesis [35][36][37][38]. Hypnotherapy is useful as reported by a recent systematic review [39].…”

“…Abdominal vagal afferents that identify potentially emetogenic substances in the lumen also terminate in this zone. Results from a wide variety of experiments show that the nucleus tractus solitarius connects to the emetic central pattern generator which is located in the retrofacial nucleus of the reticular formation playing a key role in the progression of various stimuli that will finally have the effect of emesis induction [37,38,40,41]. It controls respiratory groups that coordinate the muscular movements involved in retching and vomiting.…”