title: [Gastroparesis: pathophysiology and management].
abstract: The prevalence of gastroparesis is increasing. Diabetes mellitus and sequelae of œsogastric surgery are the two main causes of gastroparesis. In some patients, gastroparesis seems a postinfectious disease after its sudden onset after a viral infection. In about one third of the patients, gastroparesis is considered as idiopathic. In diabetic patients, gastroparesis impairs glycaemic control. Due to the low positive predictive value of symptoms, a gastric emptying study is often necessary to confirm a suspected diagnosis of gastroparesis. The symptomatic efficacy of erythromycin is higher than that of other prokinetics. This efficacy is higher when erythromycin is given intravenously. Hyperglycaemia impairs this symptomatic effect. Due to a tachyphylaxis phenomenon, the clinical effect of erythromycin decreases with the duration of treatment. In refractory gastroperis, either duodenal or jejunal enteral feeding, or high-frequency gastric electrical stimulation are possible therapeutic options while endoscopic alternatives (intrapyloric botulinum injection or pyloric balloon dilation) give unsatisfactory results.
authors.affiliation: Faculté de médecine et de pharmacie, ADEN EA 4311 hôpital Charles-Nicolle, département d'hépatogastroentérologie et de nutrition, Rouen cedex, France. philippe.ducrotte@chu-rouen.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Ducrotté
authors.forename: Guillaume
authors.initials: G
authors.lastname: Gourcerol
mesh_terms: D013505:Digestive System Surgical Procedures; D004599:Electric Stimulation Therapy / Q000379:methods / Q000706:statistics & numerical data; D004917:Erythromycin / Q000627:therapeutic use; D018589:Gastroparesis / Q000175:diagnosis / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D009037:Motilin / Q000031:analogs & derivatives / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D009037:Motilin; D004917:Erythromycin