UpToDate
Official reprint from UpToDate®
www.uptodate.com ©2016 UpToDate®

Malignancy-associated gastroparesis: Pathophysiology and management

Authors
Mehnaz A Shafi, MD
Eiad Nasser, MD
Milind Javle, MD
Section Editors
Reed E Drews, MD
Eduardo Bruera, MD
Deputy Editor
Diane MF Savarese, MD

INTRODUCTION

The management of nausea and vomiting in cancer patients is a challenging task. Gastroparesis is one of the most underdiagnosed problems in cancer patients, and often overlooked as a potential etiology of chronic nausea and vomiting.

While the exact prevalence is not known, gastroparesis is common among patients with upper gastrointestinal tract tumors (gastric, pancreatic, esophageal, and biliary) [1,2]. Pancreatic cancer-associated gastroparesis is common. Patients with pancreatic cancer often present with nausea and vomiting in the absence of mechanical obstruction [3]. These patients may also have a more generalized disorder of gastrointestinal motility, with components of dysphagia and abnormal small bowel motility (intestinal pseudo-obstruction, "functional ileus"). (See "Chronic intestinal pseudo-obstruction".)

Gastroparesis is important to recognize for many reasons.

The consequences of malignancy-associated gastroparesis can be serious, particularly in the context of other common problems that affect nutrition and fluid-electrolyte balance in cancer patients. If unrecognized and untreated, malignancy-associated gastroparesis can compound the anorexia and cachexia that often accompanies advanced cancer and the gastrointestinal side effects of specific anticancer treatments such as radiation or chemotherapy. The potential consequences include chronic nausea and vomiting, electrolyte disturbances, dehydration, hospitalization, and significant impairment of quality of life. (See "Palliative care: Assessment and management of nausea and vomiting".)

Misdiagnosis of malignancy-associated gastroparesis as chemotherapy-induced emesis can lead to delays in administration of potentially efficacious anticancer therapy.

                                  

Subscribers log in here

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information or to purchase a personal subscription, click below on the option that best describes you:
Literature review current through: Nov 2016. | This topic last updated: Mon Aug 10 00:00:00 GMT+00:00 2015.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2016 UpToDate, Inc.
References
Top
  1. Schraml FV, Krueger WH. Presentation of gastric carcinoma on a radionuclide gastric-emptying study. Clin Nucl Med 2005; 30:574.
  2. Leung VK, Kan PS, Lai MS. Cholangiocarcinoma presenting as pseudoachalasia and gastroparesis. Hong Kong Med J 2003; 9:296.
  3. Leung J, Silverman W. Diagnostic and therapeutic approach to pancreatic cancer-associated gastroparesis: literature review and our experience. Dig Dis Sci 2009; 54:401.
  4. Hewitt AN, Levine MS, Rubesin SE, Laufer I. Gastric bezoars: reassessment of clinical and radiographic findings in 19 patients. Br J Radiol 2009; 82:901.
  5. Donthireddy KR, Ailawadhi S, Nasser E, et al. Malignant gastroparesis: pathogenesis and management of an underrecognized disorder. J Support Oncol 2007; 5:355.
  6. Nguyen-tat M, Pohl J, Günter E, et al. Severe paraneoplastic gastroparesis associated with anti-Hu antibodies preceding the manifestation of small-cell lung cancer. Z Gastroenterol 2008; 46:274.
  7. Ghoshal UC, Sachdeva S, Sharma A, et al. Cholangiocarcinoma presenting with severe gastroparesis and pseudoachalasia. Indian J Gastroenterol 2005; 24:167.
  8. Caras S, Laurie S, Cronk W, et al. Case report: pancreatic cancer presenting with paraneoplastic gastroparesis. Am J Med Sci 1996; 312:34.
  9. Lautenbach E, Lichtenstein GR. Retroperitoneal leiomyosarcoma and gastroparesis: a new association and review of tumor-associated intestinal pseudo-obstruction. Am J Gastroenterol 1995; 90:1338.
  10. Gerl A, Storck M, Schalhorn A, et al. Paraneoplastic chronic intestinal pseudoobstruction as a rare complication of bronchial carcinoid. Gut 1992; 33:1000.
  11. Moskovitz DN, Robb KV. Small cell lung cancer with positive anti-Hu antibodies presenting as gastroparesis. Can J Gastroenterol 2002; 16:171.
  12. Pardi DS, Miller SM, Miller DL, et al. Paraneoplastic dysmotility: loss of interstitial cells of Cajal. Am J Gastroenterol 2002; 97:1828.
  13. Hejazi RA, Zhang D, McCallum RW. Gastroparesis, pseudoachalasia and impaired intestinal motility as paraneoplastic manifestations of small cell lung cancer. Am J Med Sci 2009; 338:69.
  14. Lee HR, Lennon VA, Camilleri M, Prather CM. Paraneoplastic gastrointestinal motor dysfunction: clinical and laboratory characteristics. Am J Gastroenterol 2001; 96:373.
  15. Argyriou KN, Peters M, Ishtiaq J, Enaganti S. A Rare Case of Paraneoplastic Syndrome Presented with Severe Gastroparesis due to Ganglional Loss. Case Rep Med 2012; 2012:894837.
  16. Darnell RB, DeAngelis LM. Regression of small-cell lung carcinoma in patients with paraneoplastic neuronal antibodies. Lancet 1993; 341:21.
  17. Lennon VA, Sas DF, Busk MF, et al. Enteric neuronal autoantibodies in pseudoobstruction with small-cell lung carcinoma. Gastroenterology 1991; 100:137.
  18. Lucchinetti CF, Kimmel DW, Lennon VA. Paraneoplastic and oncologic profiles of patients seropositive for type 1 antineuronal nuclear autoantibodies. Neurology 1998; 50:652.
  19. Vernino S, Low PA, Fealey RD, et al. Autoantibodies to ganglionic acetylcholine receptors in autoimmune autonomic neuropathies. N Engl J Med 2000; 343:847.
  20. Chinn JS, Schuffler MD. Paraneoplastic visceral neuropathy as a cause of severe gastrointestinal motor dysfunction. Gastroenterology 1988; 95:1279.
  21. Shafi MA, Pasricha PJ. Post-surgical and obstructive gastroparesis. Curr Gastroenterol Rep 2007; 9:280.
  22. Tanaka M. Gastroparesis after a pylorus-preserving pancreatoduodenectomy. Surg Today 2005; 35:345.
  23. Hirao M, Fujitani K, Tsujinaka T. Delayed gastric emptying after distal gastrectomy for gastric cancer. Hepatogastroenterology 2005; 52:305.
  24. Iftikhar S, Loftus EV Jr. Gastroparesis after celiac plexus block. Am J Gastroenterol 1998; 93:2223.
  25. Bityutskiy LP, Soykan I, McCallum RW. Viral gastroparesis: a subgroup of idiopathic gastroparesis--clinical characteristics and long-term outcomes. Am J Gastroenterol 1997; 92:1501.
  26. Brand RE, DiBaise JK, Quigley EM, et al. Gastroparesis as a cause of nausea and vomiting after high-dose chemotherapy and haemopoietic stem-cell transplantation. Lancet 1998; 352:1985.
  27. DiBaise JK, Brand RE, Lyden E, et al. Gastric myoelectrical activity and its relationship to the development of nausea and vomiting after intensive chemotherapy and autologous stem cell transplantation. Am J Gastroenterol 2001; 96:2873.
  28. Baert D, Burvenich P, Lagae J, et al. Radiotherapy-induced gastroparesis: an unusual complication. J Clin Gastroenterol 2002; 34:188.
  29. Coia LR, Myerson RJ, Tepper JE. Late effects of radiation therapy on the gastrointestinal tract. Int J Radiat Oncol Biol Phys 1995; 31:1213.
  30. Mogavero GT, Jones B, Cameron JL, Coleman J. Gastric and duodenal obstruction in patients with cholangiocarcinoma in the porta hepatis: increased prevalence after radiation therapy. AJR Am J Roentgenol 1992; 159:1001.
  31. Hoogerwerf WA, Pasricha PJ, Kalloo AN, Schuster MM. Pain: the overlooked symptom in gastroparesis. Am J Gastroenterol 1999; 94:1029.
  32. Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. Am J Gastroenterol 2008; 103:753.
  33. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol 2013; 108:18.
  34. Linke R, Meier M, Muenzing W, et al. Prokinetic therapy: what can be measured by gastric scintigraphy? Nucl Med Commun 2005; 26:527.
  35. Rentz AM, Kahrilas P, Stanghellini V, et al. Development and psychometric evaluation of the patient assessment of upper gastrointestinal symptom severity index (PAGI-SYM) in patients with upper gastrointestinal disorders. Qual Life Res 2004; 13:1737.
  36. Revicki DA, Rentz AM, Dubois D, et al. Development and validation of a patient-assessed gastroparesis symptom severity measure: the Gastroparesis Cardinal Symptom Index. Aliment Pharmacol Ther 2003; 18:141.
  37. Parkman HP, Hasler WL, Fisher RS, American Gastroenterological Association. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 2004; 127:1592.
  38. Bouras EP. Gastroparesis and electrical stimulation: can we afford the power bill? Neurogastroenterol Motil 2005; 17:2.
  39. Sturm A, Holtmann G, Goebell H, Gerken G. Prokinetics in patients with gastroparesis: a systematic analysis. Digestion 1999; 60:422.
  40. Maganti K, Onyemere K, Jones MP. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol 2003; 98:259.
  41. Nelson KA, Walsh TD. Metoclopramide in anorexia caused by cancer-associated dyspepsia syndrome (CADS). J Palliat Care 1993; 9:14.
  42. Bruera E, Seifert L, Watanabe S, et al. Chronic nausea in advanced cancer patients: a retrospective assessment of a metoclopramide-based antiemetic regimen. J Pain Symptom Manage 1996; 11:147.
  43. Rao AS, Camilleri M. Review article: metoclopramide and tardive dyskinesia. Aliment Pharmacol Ther 2010; 31:11.
  44. Desautels SG, Hutson WR, Christian PE, et al. Gastric emptying response to variable oral erythromycin dosing in diabetic gastroparesis. Dig Dis Sci 1995; 40:141.
  45. Dhir R, Richter JE. Erythromycin in the short- and long-term control of dyspepsia symptoms in patients with gastroparesis. J Clin Gastroenterol 2004; 38:237.
  46. Ramirez B, Eaker EY, Drane WE, et al. Erythromycin enhances gastric emptying in patients with gastroparesis after vagotomy and antrectomy. Dig Dis Sci 1994; 39:2295.
  47. Eagle DA, Gian V, Lauwers GY, et al. Gastroparesis following bone marrow transplantation. Bone Marrow Transplant 2001; 28:59.
  48. Sturm A, von der Ohe M, Rosien U, et al. [Treatment of radiotherapy-induced gastroparesis with erythromycin]. Dtsch Med Wochenschr 1996; 121:402.
  49. Banh HL, MacLean C, Topp T, Hall R. The use of tegaserod in critically ill patients with impaired gastric motility. Clin Pharmacol Ther 2005; 77:583.
  50. Tougas G, Earnest DL, Chen Y, et al. Omeprazole delays gastric emptying in healthy volunteers: an effect prevented by tegaserod. Aliment Pharmacol Ther 2005; 22:59.
  51. Eckhauser FE, Conrad M, Knol JA, et al. Safety and long-term durability of completion gastrectomy in 81 patients with postsurgical gastroparesis syndrome. Am Surg 1998; 64:711.
  52. Jones MP, Maganti K. A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 2003; 98:2122.
  53. Fontana RJ, Barnett JL. Jejunostomy tube placement in refractory diabetic gastroparesis: a retrospective review. Am J Gastroenterol 1996; 91:2174.
  54. Donthireddy ER, Nasser E, Tan W, et al. Malignant gastroparesis: indicator of poor prognosis (abstract #27). Data presented at the 2007 ASCO Gastrointestinal Cancers Symposium, January 19-21, Orlando, Fl.