Post-Infectious Gastroparesis: Clinical and Electerogastrographic Aspects

Timna Naftali; Ron Yishai; Tsili Zangen; Arie Levine

Disclosures

J Gastroenterol Hepatol. 2007;22(9):1423-1428. 

In This Article

Abstract and Introduction

Abstract

Aims: Post-infectious gastroparesis (PIGP) is a subgroup of idiopathic gastroparesis. The aim of this study was to identify post-viral gastroparesis and to characterize clinical and electrogastrographic aspects of the disease and their usefulness as a diagnostic tool.
Methods: Patients diagnosed with gastroparesis were defined as PIGP if they had a clear history of an acute viral illness prior to the development of their symptoms. All patients underwent evaluation of gastric emptying and electrogastrography (EGG).
Results: Seven patients met the criteria for diagnosis of PIGP. Patients' age ranged from 3 months to 47 years. A specific virus was identified in two patients (one cytomegalovirus [CMV] and one Epstein-Barr virus [EBV]). EGG was pathological in six out of seven patients. In four out of seven patients, symptoms resolved spontaneously within 4 weeks to 12 months, three patients had improved but were still symptomatic at the time of the writing of this work.
Conclusion: We conclude that post-infectious gastroparesis is an uncommon and often over looked condition. It is self-limiting in most cases. EGG is pathological in most patients.

Introduction

Normal gastric emptying is due to a complex interaction between various regions of the stomach and duodenum. These include a coordinated series of events starting with fundic accommodation of ingested food, antral contractions, pyloric relaxation, and antroduodenal coordination.[1] Interruption of this pathway may lead to altered gastric empting and subsequent disease or symptoms.

Delayed gastric empting in the absence of mechanical obstruction is called gastroparesis. The most common symptoms associated with gastroparesis are nausea and vomiting, but early satiety, abdominal discomfort and bloating may also be present.[1]

Post-viral gastroparesis (PVGP), or post-infectious gastroparesis in cases where a virus is not isolated (PIGP), is regarded as a subgroup of idiopathic gastroparesis. It usually presents with persistent vomiting and weight loss after an acute self-limiting, presumably viral illness.[2,3] By the time the patient comes to clinical attention, the acute illness has often resolved and the causative agent is difficult to detect. Diagnosis is based on the clinical setting, exclusion of other causes for persistent vomiting, and confirmation of delayed gastric emptying. Viruses of the herpes family, gastrointestinal and respiratory viruses have all been implicated in this disease. Patients can remain symptomatic for months or years, and there is no effective treatment at this time.[1,2,3,4,5,6] While the presentation of gastroparesis and the prolonged symptoms may cause a great deal of consternation and the performance of a large battery of tests, the disease appears to be self-limiting in the majority of patients. In children the duration tends to be shorter and the disease itself milder. In fact, PIGP may be a common and unrecognized disorder, especially at the milder end of the spectrum of disease. Some patients may have a short duration of symptoms and therefore never reach evaluation. Others might reach evaluation, but will not be diagnosed if gastric emptying is not evaluated.

The precise mechanism causing PVGP is unknown. Two previous studies in small cohorts of children serve as the major source of information on this disease to date. The role of gastric dysrhythmias in gastroparesis, or specifically in PIGP, has not been defined. Electrogastrography (EGG) is a technique that measures slow wave potentials originating from the stomach and analyzes their frequency. These slow wave potentials are the initiators of gastric contractions. Disruption of gastric slow wave rhythm correlates with impaired gastric emptying.[7] Previous studies did not evaluate the EGGs during post-viral gastroparesis.

The aim of this study was to identify patients with post-infectious gastroparesis and to assess clinical symptoms, the course of the disease and electrogastrographic characteristics of this disorder.

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