Diagnosis

Diagnosis:

• diagnosis of gastroparesis is based on the presence of symptoms or typical signs combined with a delay in gastric emptying proven by objective methods
  • mechanical outlet obstruction and other (extra) luminal pathology should be excluded preferably by gastrointestinal endoscopy
  • presence of retained food in the stomach while fasting overnight or the presence of a bezoar in the stomach during endoscopy is highly suggestive of delayed gastric emptying

Symptoms and signs

• gastroparesis is associated with upper gastrointestinal symptoms such as nausea, vomiting and postprandial fullness
  • repeated vomiting several hours after eating is highly suggestive of gastroparesis
  • symptoms of idiopathic gastroparesis overlap with those of functional dyspepsia
    • abdominal pain and discomfort predominate in functional dyspepsia, whereas nausea, vomiting, bloating, postprandial fullness and early satiety predominate in idiopathic gastroparesis

Gastric emptying testing includes:

• scintigraphy
  • gastric emptying scintigraphy of a radiolabeled solid meal is the gold standard for the diagnosis of gastroparesis
    • test provides a physiological, non-invasive and quantitative measure of gastric emptying
    • measurement of emptying of solids is more sensitive by scintigraphy
      • due to the fact that liquid emptying may remain normal despite advanced disease. A variety of foods including chicken, liver, eggs, egg whites, oatmeal, or pancakes are used as meals
      • content of the meal is one of the most important variables in gastric emptying
        • solids versus liquids, indigestible residue, fat content, calories and volume of the test meal, can all alter gastric emptying time
        • consensus recommendations for a standardized gastric emptying procedure have recommended a universally acceptable 99-m technetium sulfur-colloid labeled low fat, egg-white meal (1)
• stable isotope breath test
  • non-invasive isotope breath test has been proposed as a valid test to measure gastric emptying of a solid meal in health and disease
• antropyloroduodenal manometry
  • provides objectively determined data on antral, duodenal and pyloric motor function
    • in gastroparesis, several motor patterns are distinguished, including postprandial antral hypomotility because of infrequent contractions and/or low amplitudes, abnormal propagation of antroduodenal contractions, increased pyloric spasms, characterized by an increased tonic and phasic activity, and abnormal migrating motor complexes (MMC), originating less frequently from the stomach
      • different motor patterns provide some insight into the aetiology of the motor dysfunction at hand. Hypomotility that is characterized by low amplitudes is suggestive of an underlying myopathy, whereas hypomotility characterized by infrequent contractions and abnormal propagation is suggestive of an underlying neuropathy

Reference:

• 1) Abell TL et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine.Am J Gastroenterol. 2008 Mar;103(3):753-63. Epub 2007 Nov 19.
• 2) Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerationsWorld J Gastroenterol. 2009 Jan 7;15(1):25-37
• 3) Haans JJ, Masclee AA.The diagnosis and management of gastroparesis. Aliment Pharmacol Ther. 2007 Dec;26 Suppl 2:37-46