Department of Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia.
Gastroenterology, Campbelltown Hospital, Sydney, New South Wales, Australia.
Intern Med J. 2020 Aug;50(8):909-917. doi: 10.1111/imj.14438.
Gastroparesis is a syndrome characterised by delayed gastric emptying in the absence of mechanical obstruction. Symptoms can include early satiety, abdominal pain, bloating, vomiting and regurgitation which cause significant morbidity in addition to nutritional deficits. There is a higher prevalence in diabetics and females, but the incidence in the Australian population has not been well studied. Management of gastroparesis involves investigating and correcting nutritional deficits, optimising glycaemic control and improving gastrointestinal motility. Symptom control in gastroparesis can be challenging. Nutritional deficits should be addressed initially through dietary modification. Enteral feeding is a second-line option when oral intake is insufficient. Home parenteral nutrition is rarely used, and only accessible through specialised clinics in the outpatient setting. Prokinetic medication classes that have been used include dopamine receptor antagonists, motilin receptor agonists, 5-HT receptor agonists and ghrelin receptor agonists. Anti-emetic agents are often used for symptom control. Interventional treatments include gastric electrical stimulation, gastric per-oral endoscopic myotomy, feeding jejunostomy and gastrostomy/jejunstomy for gastric venting and enteral feeding. In this article we propose a framework to manage gastroparesis in Australia based on current evidence and available therapies.
胃轻瘫是一种以胃排空延迟为特征的综合征，而无机械性梗阻。其症状包括早饱、腹痛、腹胀、呕吐和反流，除了营养缺乏外，还会导致严重的发病率。糖尿病和女性的患病率较高，但在澳大利亚人群中的发病率尚未得到很好的研究。胃轻瘫的治疗包括调查和纠正营养缺乏、优化血糖控制和改善胃肠道动力。胃轻瘫的症状控制具有挑战性。首先应通过饮食调整来解决营养缺乏问题。当口服摄入不足时，肠内喂养是二线选择。家庭肠外营养很少使用，只能通过门诊专门诊所获得。已使用的促动力药物类别包括多巴胺受体拮抗剂、胃动素受体激动剂、5-HT 受体激动剂和生长激素释放肽受体激动剂。止吐药物常用于控制症状。介入治疗包括胃电刺激、胃经口内镜肌切开术、喂养空肠造口术和胃造口术/空肠造口术以进行胃通气和肠内喂养。在本文中，我们根据现有证据和可用疗法，提出了一个在澳大利亚管理胃轻瘫的框架。
