Gastroparesis in patients with inactive Crohn's disease: a case series.
BACKGROUND
Few studies have described patients with foregut dysmotility in inflammatory bowel disease. The aim of this case series was to evaluate clinical characteristics of 5 patients with inflammatory bowel disease and symptoms and signs of upper gut dysmotility.


METHODS
We describe a series of four patients with Crohn's disease and one with indeterminate colitis who presented with severe symptoms and signs of gastroparesis. We reviewed medical records of all cases. Gastric emptying of a solid meal was assessed by scintigraphy. Small bowel enteroclysis, gastroduodenoscopy and colonoscopy with biopsies were performed to estimate the activity of the disease and to exclude organic obstruction. None of the patients had any signs of active inflammation or stricture. All of the patients had markedly delayed gastric emptying with a mean t 1/2 of 234 minutes (range 110-380 minutes; normal values 54-94 minutes).


CONCLUSIONS
Clinicians should consider impaired gastric emptying when evaluating patients with Crohn's disease and severe symptoms of upper gut dysmotility, which cannot be attributed to active inflammation or organic obstruction of the digestive tract. Symptoms in these patients are refractory to various therapeutic interventions including tube feeding and gastric surgery.
Kristinsson
Jón O
JO
Department of Gastroenterology and Hepatology, Radboud University Medical Center, Nijmegen, The Netherlands. J.Kristinsson@mdl.umcn.nl
Hopman
Wim P M
WP
Oyen
Wim J G
WJ
Drenth
Joost P H
JP
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D000963:Antimetabolites / Q000627:therapeutic use; D001379:Azathioprine / Q000627:therapeutic use; D003424:Crohn Disease / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D004359:Drug Therapy, Combination; D005260:Female; D005763:Gastroenterostomy; D018589:Gastroparesis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy; D006801:Humans; D015122:Mercaptopurine / Q000627:therapeutic use; D008875:Middle Aged; D013866:Thioguanine / Q000627:therapeutic use; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000963:Antimetabolites; D015122:Mercaptopurine; D013866:Thioguanine; D001379:Azathioprine