Gastroenterology [MISC GASTRIC DISORDERS]

Gastroparesis
Gastroparesis (“think Gastro-paralysis”) is a nerve problem with
the stomach whereby digested food just won’t go forward. In
other words, the stomach can’t empty. The most common cause
is idiopathic, though it's often associated with autonomic
neuropathy, especially diabetic neuropathy (neuropathy of the
vagus nerve).

Chronic nausea, vomiting, and early satiety is classic for

gastroparesis. Severe abdominal pain isn’t typical it. However,
on inpatient medicine rotations you’ll encounter patients
suffering with intractable pain secondary to their gastroparesis.

The diabetic with gastroparesis must have peripheral neuropathy

in their feet for the diagnosis – the longest nerves are affected
first. Often they’ll be poorly controlled as well. Control of the
blood sugar is paramount to limit diabetic gastroparesis.

An endoscopy is often performed for these patients because

they present with chronic nausea and vomiting. While this can
rule out other diagnoses (such as malignancy and gastric outlet
obstruction), the EGD is non-diagnostic for gastroparesis. To
diagnose it, a gastric emptying study is performed.

The treatment of gastroparesis uses prokinetic agents as the

cornerstone of therapy. Oral Metoclopramide is best used for
chronic management while intravenous Erythromycin is used
for acute exacerbations. Consuming small meals with little
fiber also helps. Avoid opiates and anticholinergic
medications.

Severe, refractory cases may result in the use of gastric

stimulators or tube feeds that bypass the pylorus. In extreme
cases, parenteral nutrition may be required.

MALToma
The “good” gastric cancer, this is a Gastric Lymphoma. It’s
caused by infection by H. pylori. It’s found and diagnosed by
endoscopy with biopsy. Treating the H. pylori treats the cancer.
Use triple therapy (see peptic ulcer disease for more).

Gastric Adenocarcinoma
One of the rarer forms of malignancy in the United States, the
pathogenesis of Gastric Adenocarcinoma is poorly understood.
Japanese diets, particularly those rich in nitrate preservatives
increases the risk. Hence, most new gastric adenocarcinomas are
diagnosed in East Asia, particularly China and Japan. There is
currently no screen for Gastric Cancer. When advanced, the
symptoms will be early satiety, weight loss, and bowel
obstruction. The test of choice is endoscopy to diagnose, then
PET-CT to stage. Most (80-90%) of adenocarcinomas are
metastasized at the time of diagnosis; prognosis is poor.

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