Gastroparesis differential diagnosis

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https://www.wikidoc.org/index.php/Gastroparesis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Syed Hassan A. Kazmi BSc, MD [2]

Overview

Gastroparesis should be differentiated from other diseases that cause chronic nausea and vomiting. The differentials include psychiatric illnesses, rumination syndrome, functional dyspepsia and cyclic vomiting syndrome.

Differentiating Gastroparesis from other Diseases

Gastroparesis should be differentiated from other diseases that cause chronic nausea and vomiting. The differentials include the following:[1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32]

Disorder Clinical features Laboratory findings
Chronic nausea Vomiting Diarrhea Retching Lethargy Social withdrawal Photophobia Epigastric pain/burning Lanugo hair Hypogonadism Russel's sign Body mass index (normal range: 18.5 to 24.9) Complete blood count (CBC) Electrolyte imabalance Lipase and amylase levels Gastric scintigraphy Ambulatory esophageal pH and impedance testing
Gastroparesis ✔ (within 1 hour of eating) - - - - - -
  • Normal (maybe elevated if chronic renal failure is the cause of gastroparesis- usually less than threefold)
  • Periodic measurement of radiolabeled solid meal:  
    • Grade 1 (mild), 11%-20% retention at 4 h
    • Grade 2 (moderate), 21%-35% retention at 4 h
    • Grade 3 (severe), 36%-50% retention at 4 h
    • Grade 4 (very severe), > 50% retention at 4 h
  • Impedance testing (antroduodenal manometery): Loss of normal fasting migratory motor complexes (MMCs) and reduced postprandial antral contractions and, in some cases pylorospasm
Anorexia nervosa - - - -
  • Increased
Bulimia nervosa - - - Normal
  • Increased
Rumination syndrome ✔ (Regurgitation more common- within minutes of meal intake) - - - -
  • Normal
  • Normal
  • Esophageal pH: Fall in esophageal pH immediately after reguritation (occurs while patient is awake and erect; this is in contrast to GERD, where reflux occurs diurnally and supine position)
Functional dyspepsia - - - - - - - Normal
  • Normal
  • Esophageal pH: May be decreased if patient develops reflux
Cyclic vomiting syndrome - - - - - - -
  • Rapid or normal
  • Esophageal pH: Decreased
Pancreatitis - - - - - Normal
  • Increased
  • Not indicated
  • Esophageal pH: Normal
Gastric outlet obstruction ✔ (within 1 hour of eating) - - - - - - - -
  • Esophageal pH: Increased
  • Esophageal manometery:   High manoraetric score

References

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