William L. Hasler, MD

Disclosures

Medscape J Med. 2008;10(1):16 

In This Article

Differential Diagnosis

Symptoms of gastroparesis can mimic those of other conditions. Mucosal inflammation can exacerbate gastroparesis symptoms. In one investigation of patients with presumed gastroparesis flares, upper endoscopy revealed Candida esophagitis or acid-peptic disease in some individuals who responded to treatments other than those given specifically for gastroparesis.[87]

Some patients with diabetes report severe nausea and vomiting yet exhibit no gastric retention. Indeed, in a recent report of patients with suspected gastroparesis, GCSI scores correlated poorly with gastric emptying rates.[88] Only postprandial fullness showed a weak association with gastric retention. Impaired postprandial fundic accommodation has been observed in some diabetic patients.[89] In another study involving patients with type 1 diabetes with dyspepsia, gastric distention evoked exaggerated nausea, bloating, and abdominal pain, suggesting defects in visceral afferent function.[90] However, in studies employing evoked potential testing, afferent neuropathy was associated with fewer rather than more symptoms.[91] The correlation of accommodation and visceral sensory defects with the degree of symptoms in diabetic patients has not been well studied.

Symptoms in some patients with idiopathic gastroparesis also stem from defects other than delayed emptying. In one recent study, 43% of patients had impaired fundic accommodation which was associated with early satiety and weight loss, and 29% exhibited heightened sensitivity to gastric distention, which was related to the degrees of epigastric pain, early satiety, and weight loss.[92] Idiopathic gastroparesis may be difficult to distinguish from functional dyspepsia in some cases, leading some to speculate they are variants of the same disorder. As with idiopathic gastroparesis, some patients with functional dyspepsia present after an acute infection.[93] Furthermore, 25% to 50% of patients with functional dyspepsia exhibit delayed emptying.[80,94] The postprandial distress subtype of functional dyspepsia in the current Rome III classification system is characterized by gastroparesis-like symptoms, including postprandial fullness and early satiety.[80] Other Rome III diagnoses with symptom overlap with idiopathic gastroparesis include chronic idiopathic nausea and functional vomiting.[80] The prevalence of delayed emptying in these syndromes has not been characterized. From a diagnostic standpoint, a presentation of predominant pain and less nausea is considered to be more typical of functional dyspepsia, whereas dominant nausea with minimal pain is more consistent with idiopathic gastroparesis.[1]

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