Beruflich Dokumente
Kultur Dokumente
Ali Djumhana
Div. Gastroenterology dan Hepatologi
Bagian Ilmu Penyakit Dalam RS Hasan Sadikin – FK Unpad
Bandung
Gastroparesis
4% 3%
4%
28% Idiopathic
10%
Postviral
Diabetic
Postsurgical
14% Parkinsons
8% Pseudoobstruction
Scleroderma
Miscellaneous
29%
Soykan I et al. (1998)
Epidemiology
Female > Male (~ 4:1)
Delayed gastric emptying were found :
– 20 - 40 % of pts with F D
– 26 - 68% % of pts with Diabetes
Incidence of delayed gastric emptying:
– 4.5% DM 1
– 1% DM 2
– 0.1% Non DM
Physiology of Gastric motility
Regulation of gastric motility
=Parasympatetic ( N Vagus)
=Sympatetic
=Enteric neural system
=Neurotransmitter
(Acetylcholine,dopamin,
serotonin)
=Hormone ( glucose regulating
hormone)
=Food composition
(fat,CHO,solid,fluid)
Physiology of gastric motility
Motor function of stomach is controlled at three
main levels
Autonomic nervous system
Enteric neuronal system
Interstitial Cell of Cajal
Smooth muscle cell
Several subsystems are involved:
afferent receptors
neurohumoral substances
circulating hormones
ICCs
ICCs
Motility of the gut
inhibition
excitation
Physiology of gastric emptying
Gut 2010;59:1716-1726
Pathophysiology Diabetic gastroparesis
Pathophysiology of Gastroparesis
HT and PE
Laboratory testing
Evaluation for organic disorders
Evaluation for delayed gastric emptying
Evaluation of response to treatment trial
Further evaluation
History taking and Physical Examination
HT
Differentiated of vomiting from regurgitation and ruminating
Risk factors
Poor glycaemic controlled
Female
History of medication (GLP-1 agonist/receptor analogue,etc)
PE
Hydration status
Nutrition status
Succussion splash
Diagnosis
Gut 2010;59:1716-1726
Evaluation of patients
Suspected Gastroparesis
Test to assess gastric motor and myoelectrical function
Nutrition;glycaemic control
Empiric trial of prokinetic for 4-8 wks
No improvement
Improvement
Abnormal Normal
Improvement No Improvement
High dose prokinetic
Re-evaluate the D/
Or other modalities
Conclusion (1)
Gastroparesis is a syndrome characterized
by delayed gastric emptying in the
absence of mechanical obstruction
Diabetic gastroparesis is the main cause of
gastroparesis
Scintigraphy is a gold-standard for
diagnosis
Conclusion (2)
Patients with presumptive diagnosis
gastroparesis should be cared for empirical /
trial treatment.
The treatment include ;Nutrition teraphy
(Macro and micro nutrient,vitamins
etc), metabolic control and prokinetic agent
Novel treatment including new
prokinetics, botulinum toxin injection,gastric
electrical stimulation have been tested in
patients with gastroparesis