Diabetic gastroparesis is characterized as onset of symptoms of gastroparesis in patients with diabetes, with concomitant delayed gastric emptying. It is often attributed to chronic hyperglycemia-induced damage to the vagus nerve, and is frequently observed in association with other diabetic complications such as neuropathy, retinopathy, and nephropathy.10
Gastroparesis that develops following surgery is classified as postsurgical gastroparesis. In the past, this form of gastroparesis most commonly occurred after ulcer surgery, often performed with vagotomy. These types of surgeries are performed less frequently in the era of proton pump inhibitor therapy and treatments for Helicobacter pylori. Presently, Nissen fundoplication and bariatric surgery are the more common surgical procedures associated with gastroparesis.3 Long-term use of medications that delay gastric emptying, such as opiate narcotic medications, can lead to gastroparesis and represent another form of iatrogenic gastroparesis. Other forms of gastroparesis (atypical gastroparesis) arise due to various underlying etiologies, including neurological disorders (eg, Parkinson disease, multiple sclerosis), metabolic or endocrine conditions (eg, hypothyroidism), autoimmune disorders, connective tissue and collagen vascular disorders (eg, systemic lupus erythematosus, scleroderma, Sjögren syndrome, Ehlers-Danlos syndrome), or eating disorders (eg, anorexia, bulimia).3
Epidemiology
There is a female preponderance in patients with gastroparesis. Data from the Rochester Epidemiology Project, a database of linked medical records for residents of Olmsted County, MN, showed that the age-adjusted prevalence of definite gastroparesis per 100,000 inhabitants was 37.8 for women and 9.6 for men.11 More recent estimates have suggested a much higher prevalence of probable gastroparesis (approximately 1.8%) in the general population using symptoms suggestive of gastroparesis.12 Hospitalization rates for gastroparesis have increased since 2000, which could reflect rising prevalence and/or the effects of heightened awareness about and better identification of gastroparesis.13 This increase may also be due in part to the rising rate of diabetes leading to more cases of diabetic gastroparesis; withdrawal of some gastroparesis treatments from the market (cisapride, tegaserod) leading to hospitalizations for symptoms not adequately being treated; and hospitalizations needed for insertion of the gastric electric stimulator.
Gastroparesis Symptoms
The main symptoms of gastroparesis are early satiety, postprandial fullness, bloating, nausea, and vomiting.14 Nausea (> 90% of patients) and early satiety (60% of patients) are the most common symptoms.15 Abdominal pain is often present in patients with gastroparesis but is usually not the predominant symptom. The pain can be multifactorial, with somatic, visceral, and neuropathic components.16-18 Moderate to severe abdominal pain has been found more often in patients with idiopathic gastroparesis and in association with opiate use.16 Symptoms of gastroparesis may be persistent or present as episodic flares. Due to the symptoms, some patients will experience weight loss and malnutrition and, in severe cases, dehydration.19
Although the definition of gastroparesis is a delay in gastric emptying along with symptoms, symptoms correlate poorly with the degree of delayed gastric emptying. The symptoms that appear to have the strongest correlation with gastric emptying are nausea, vomiting, early satiety, and postprandial fullness, whereas symptoms such as abdominal pain and bloating have little correlation. Furthermore, improving gastric emptying does not necessarily lead to improved symptoms, and symptom improvement does not always lead to improved gastric emptying times.20 Between 5% and 12% of patients with diabetes report symptoms consistent with gastroparesis, though many of these patients have normal gastric emptying. The symptoms of gastroparesis overlap with those of functional dyspepsia, as both may have motor and sensory alterations.21
