Mistakes in gastroparesis and how to avoid them

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Mistakes in gastroparesis and how to avoid them

Asma Fikree

Summary

AI Generated

This article examines common diagnostic mistakes in gastroparesis, a condition defined by delayed gastric emptying with nausea and vomiting, which has seen a dramatic rise in US diagnoses from 21 cases in 1958 to 5 million in 2019.

Gastroparesis is defined as delayed gastric emptying associated primarily with nausea and vomiting in the absence of mechanical obstruction, first described by Kassander in 1958 as 'gastroparesis diabeticorum'
Hospital admissions for gastroparesis are rising much faster than for related conditions such as nausea and vomiting, gastro-oesophageal reflux disease, gastritis or gastric ulcers, which remain relatively static, representing a major healthcare burden
The author suggests the rapid increase in prevalence likely occurred because it has become easier to measure gastric emptying and attribute symptoms without necessarily considering differential diagnoses
Most cases are caused by diabetes (type 1 more than type 2) or surgical procedures disrupting the vagus nerve such as Billroth gastrectomy, oesophagectomy, gastric bypass surgery and fundoplication, though cases can be idiopathic
Clinicians managing patients with suspected gastroparesis would benefit from understanding the most frequent diagnostic mistakes in this condition

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48: 797–812. [Link]

Wang YR, Fisher RS and Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol 2008; 103: 313–322. [Link]

Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology 2011; 140: 101–115. [Link]

Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol 2008; 36: 44–54. [Link]

Murray HB, Jehangir A, Silvernale CJ, et al. Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis. Neurogastroenterol Motil 2020; 32: e13931. [Link]

Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543. [Link]

Olausson EA, Störsrud S, Grundin H, et al. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol 2014; 109: 375–385. [Link]

Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403. [Link]

Erbas T, Varoglu E, Erbas B, et al. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993; 16: 1511–1514. [Link]

10.

Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol 2019; 114: 1265–1274. [Link]

11.

Jehangir A and Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol 2017; 23: 7310–7320. [Link]

12.

Fass R, McCallum RW and Parkman HP. Clinical Roundtable Monograph: Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol 2009: 5 (Suppl 18); 4–11. [Link]

13.

Calles-Escandón J, Koch KL, Hasler WL, et al. Glucose sensor-augmented continuous subcutaneous insulin infusion in patients with diabetic gastroparesis: an open-label pilot prospective study. PLoS One 2018; 13: e0194759. [Link]

14.

Parkman HP, Wilson LA, Hasler WL, et al. Abdominal pain in patients with gastroparesis: associations with gastroparesis symptoms, etiology of gastroparesis, gastric emptying, somatization, and quality of life. Dig Dis Sci 2019; 64: 2242–2255. [Link]

15.

Zoll B, Jehangir A, Malik Z, et al. Gastric electric stimulation for refractory gastroparesis. J Clin Outcomes Manag 2019; 26: 27–38. [Link]

Abstract

The term ‘gastroparesis’ was first coined by Kassander in 1958 to describe the fact that barium did not leave the stomach of patients with diabetes for over 24 hours — so-called ‘gastroparesis diabeticorum’. Nowadays it refers to a delay in gastric emptying that is associated with symptoms primarily of nausea and vomiting as well as the absence of mechanical obstruction. In 1958, 21 cases were described, but in 2019, 5 million US individuals were diagnosed as having gastroparesis. This rapid increase in prevalence is likely to have occurred because it has become much easier to measure gastric emptying and to attribute symptoms to this without necessarily thinking through differentials. The incidence of hospital admissions for patients labelled as having gastroparesis is rapidly rising, increasing at a much faster rate than admissions for patients with nausea and vomiting, gastro-oesophageal reflux disease, gastritis or gastric ulcers, which are all remaining relatively static. Gastroparesis therefore represents a major healthcare burden. Gastroparesis can be idiopathic or is most frequently caused by diabetes (type 1 more than type 2) or surgical procedures that can disrupt the vagus nerve (e.g. Billroth gastrectomy, oesophagectomy, gastric bypass surgery and fundoplication). In this article, I describe the mistakes most frequently made in patients who have a suspected diagnosis of gastroparesis. I base my discussion on the available evidence as well as clinical experience in the field.

Topics

Neurogastroenterology & Motility Stomach & H. Pylori

Citation

Fikree A. Mistakes in gastroparesis and how to avoid them. UEG Education 2021; 21: 18–22.

Published

2021

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Mistakes in ostomy management and how to avoid them

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48: 797–812. [Link]

Wang YR, Fisher RS and Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol 2008; 103: 313–322. [Link]

Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543. [Link]

Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403. [Link]

Erbas T, Varoglu E, Erbas B, et al. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993; 16: 1511–1514. [Link]

10.

Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol 2019; 114: 1265–1274. [Link]

11.

Jehangir A and Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol 2017; 23: 7310–7320. [Link]

12.

Fass R, McCallum RW and Parkman HP. Clinical Roundtable Monograph: Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol 2009: 5 (Suppl 18); 4–11. [Link]

13.

14.

15.

Zoll B, Jehangir A, Malik Z, et al. Gastric electric stimulation for refractory gastroparesis. J Clin Outcomes Manag 2019; 26: 27–38. [Link]

Abstract

Ostomy management refers to the care and maintenance of an ostomy and involves various aspects to ensure the individual’s health, comfort, and quality of life. This should involve the patient, a close support system (family and/or friends), and a healthcare team, including ostomy nurses and healthcare professionals specialising in ostomy care.

Topics

Primary Care

Published

2025

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Published

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Abstract

Topics

Hepatobiliary

Published

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48: 797–812. [Link]

Wang YR, Fisher RS and Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol 2008; 103: 313–322. [Link]

Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543. [Link]

Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403. [Link]

Erbas T, Varoglu E, Erbas B, et al. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993; 16: 1511–1514. [Link]

10.

Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol 2019; 114: 1265–1274. [Link]

11.

Jehangir A and Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol 2017; 23: 7310–7320. [Link]

12.

Fass R, McCallum RW and Parkman HP. Clinical Roundtable Monograph: Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol 2009: 5 (Suppl 18); 4–11. [Link]

13.

14.

15.

Zoll B, Jehangir A, Malik Z, et al. Gastric electric stimulation for refractory gastroparesis. J Clin Outcomes Manag 2019; 26: 27–38. [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

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Citation

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Published

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Summary

AI Generated

Summary is not available for this content yet.

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References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48: 797–812. [Link]

Wang YR, Fisher RS and Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol 2008; 103: 313–322. [Link]

Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543. [Link]

Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403. [Link]

Erbas T, Varoglu E, Erbas B, et al. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993; 16: 1511–1514. [Link]

10.

Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol 2019; 114: 1265–1274. [Link]

11.

Jehangir A and Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol 2017; 23: 7310–7320. [Link]

12.

Fass R, McCallum RW and Parkman HP. Clinical Roundtable Monograph: Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol 2009: 5 (Suppl 18); 4–11. [Link]

13.

14.

15.

Zoll B, Jehangir A, Malik Z, et al. Gastric electric stimulation for refractory gastroparesis. J Clin Outcomes Manag 2019; 26: 27–38. [Link]

Abstract

Children and adolescents with chronic diseases requiring lifelong care face unique challenges that affect their daily lives and those of their families. Initially, these patients receive specialized care in pediatric facilities, where parents play a key role in treatment decisions. However, transitioning to adult healthcare facilities is inevitable, and this process, recognized as crucial years ago, involves moving adolescents with chronic conditions from child-centered to adult-oriented care. This transition can be complicated by varying age limits for pediatric care and the scarcity of adult care centers with specific expertise. The transition often requires cooperation between different centers or even countries due to patient mobility. The transition phase is critical, as it can lead to loss of follow-up, treatment suspension, and increased risks of complications or disease relapse. Beyond medical management, various factors influence the long-term prognosis of chronic conditions, making a well-organized transition program essential. While many hospitals have implemented transition models with mixed results in satisfaction, disease control, and follow-up adherence, there are frequent shortcomings in the process. This Mistakes In article will outline eight common mistakes made during the transition from pediatric to adult care, supported by literature and professional experience.

Topics

Primary Care

Citation

Jorge Amil-Dias, Hans Törnblom, Moriam Mustapha and Patrizia Burra. Mistakes in transitional care for children and young adults and how to avoid them. UEG Education 2023; 23: 22-25.

Published

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Abstract

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Published

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