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Gastroparesis and Cancer-Related Gastroparesis

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Textbook of Palliative Care

Abstract

Gastroparesis is an underrecognized cause of nausea, vomiting, early satiety, postprandial fullness, and weight loss in advanced cancer. Causes for gastroparesis include reduced pyloric compliance and mobility, impaired duodenal contractions, widespread neuropathy, and selective loss of interstitial cells of Cajal. Patients with cancer may develop gastroparesis because of chemotherapy-induced neuropathy, immunosuppression followed by opportunistic viral infections involving the gastrointestinal tract, procedures such as celiac blocks, paraneoplastic neuropathy or myopathy, and as a sequalae of graft-versus-host disease after allogeneic bone marrow transplant. The symptoms of gastroparesis do not correlate with the degree of impairment observed in gastric emptying studies. Treatment includes prokinetics such as metoclopramide, erythromycin, azithromycin, and domperidone. Symptoms may respond to mirtazapine, granisetron, and acupuncture. Gastric electrical stimulation and pyloromyotomy procedures have been reported to reduce symptoms, but there are no randomized trials to validate either procedure. In those failing to respond to medical management, a percutaneous endoscopy-placed gastric tube for decompression with a jejunal extension feeding tube (PEG-J) can be used to reduce symptoms and provide nutrition.

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  1. Department of Palliative Care, Geisinger Medical Center, Danville, PA, USA

    Mellar P. Davis, Renee Weller & Sally Regel

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  1. Mellar P. Davis
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  2. Renee Weller
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  3. Sally Regel
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    Roderick Duncan MacLeod

  2. Vrije Universiteit Brussel, VUB-UGent End-of-Life Care Research Grou Vrije Universiteit Brussel, Brussels, Belgium

    Lieve van den Block

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Davis, M.P., Weller, R., Regel, S. (2018). Gastroparesis and Cancer-Related Gastroparesis. In: MacLeod, R., van den Block, L. (eds) Textbook of Palliative Care. Springer, Cham. https://doi.org/10.1007/978-3-319-31738-0_114-1

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