Review Question - QID 102676

This patient is suffering from gastroparesis/delayed gastric emptying given her poorly managed diabetes (elevated hemoglobin A1c) and symptoms of early satiety, bloating, and regurgitation. The initial treatment for this condition is diet modification to frequent and small meals that are low in fiber and fat.

Presenting symptoms of gastroparesis include nausea, vomiting, early satiety, postprandial fullness, abdominal pain, and bloating. The management of diabetic gastroparesis is first improving blood glucose control, increasing liquids in the patient's diet, transitioning to smaller and more frequent meals throughout the day, stopping the use of tobacco and alcohol, and decreasing the amount of insoluble fiber and fat in the patient's diet. If this initial management fails, pharmacologic management can include prokinetic agents such as metoclopramide and erythromycin.

Incorrect Answers:
Answers 2-3: Erythromycin and metoclopramide are pro-kinetic agents that are indicated in the treatment of gastroparesis; however, dietary modifications should be attempted first before pursuing pharmacologic treatment.

Answer 4: Myotomy would be indicated in the management of achalasia which typically presents in young patients with regurgitation of undigested food secondary to increased tone of the lower esophageal sphincter. The diagnosis can be confirmed with a barium swallow (showing a bird beak taper) and manometry (showing increased lower esophageal sphincter tone).

Answer 5: Surgical resection is the definitive treatment of Zenker diverticulum which presents in elderly patients with regurgitation of undigested food. The spastic cricopharyngeal muscle leads to an outpouching that can surgically be removed. This condition would not present with early satiety and bloating.

Bullet Summary:
The most appropriate initial step in the management of diabetic gastroparesis is tighter glycemic control and small meals that have a low osmotic load.