Diagnosis and treatment of gastroparesis in cirrhotic patients

Christopher J. Danford, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Daniela Goyes, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Hirsh D. Trivedi, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA
Alan Bonder, Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Boston, MA, USA

Malnutrition is a common complication of cirrhosis resulting in increased morbidity and mortality in this population. Gastroparesis is highly prevalent in cirrhosis affecting up to 75% of patients and may contribute significantly to malnutrition. The pathophysiology of cirrhotic gastroparesis is poorly understood but is associated with autonomic dysfunction and hormonal dysregulation seen in cirrhosis. Gastroparesis is diagnosed by > 10% retained gastric contents at 4 h on solid-phase gastric scintigraphy, the gold standard for diagnosis in both cirrhotic and non-cirrhotic patients. Treatment of gastroparesis should focus on the reversal of malnutrition with a low-residue, and low-fat diet. Long-term nasojejunal tube feeds may be required in those able to maintain nutrition orally. Evidence for the effectiveness of prokinetic therapy in cirrhosis is sparse, though metoclopramide and cisapride are likely safe with appropriate dose reduction and monitoring. Large-volume paracentesis does not improve gastric emptying, though improves nutrition generally. Liver transplant improves gastrointestinal symptoms, but evidence for improvement of gastric emptying is lacking.

Keywords: Cirrhosis. Pathophysiology. Gastroparesis.