Malignancy-associated gastroparesis: Pathophysiology and management
- Mehnaz A Shafi, MD
Mehnaz A Shafi, MD
- Professor of Medicine
- Department of Gastroenterology, Hepatology and Nutrition
- MD Anderson Cancer Center
- Eiad Nasser, MD
Eiad Nasser, MD
- University at Buffalo
- Gastroenterology Division
- Milind Javle, MD
Milind Javle, MD
- Professor of Medicine
- University of Texas MD Anderson Cancer Center
- Department of GI Medical Oncology
- Section Editors
- Reed E Drews, MD
Reed E Drews, MD
- Section Editor — Complications of Cancer
- Associate Professor of Medicine
- Harvard Medical School
- Eduardo Bruera, MD
Eduardo Bruera, MD
- Section Editor — Non Pain Symptoms: Assessment and Management
- Professor of Oncology
- University of Texas, MD Anderson Cancer Center at Houston
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 . 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.
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- PHYSIOLOGY OF GASTRIC EMPTYING
- ETIOLOGY AND PATHOGENESIS
- Paraneoplastic gastrointestinal dysmotility
- Postsurgical dysmotility
- Celiac plexus injury
- High-dose chemotherapy and stem cell transplantation
- Radiation therapy
- CLINICAL FEATURES AND DIAGNOSIS
- Diagnostic workup
- - Gastric emptying scintigraphy
- - Alternatives to scintigraphy
- Quantifying symptom severity
- General approach
- Dietary and behavioral modification
- - Metoclopramide
- - Erythromycin
- - Cisapride
- - Tegaserod
- - Domperidone
- - Antiemetic agents
- Treatment considerations for paraneoplastic dysmotility
- Management options for refractory cases
- - Decompression
- - Other operative interventions
- - Gastric electrical stimulation
- - Botulinum treatment
- Nutrition issues
- - Enteral nutrition
- - Indications for parenteral nutrition
- PROGNOSTIC IMPACT OF GASTROPARESIS
- SUMMARY AND RECOMMENDATIONS