Daniel C BucklesMD and Richard W McCallum MD

The diagnosis of gastroparesis should be firmly established by ruling out mechanical obstruction with endoscopy and barium studies and demonstrating delayed gastric emptying by nuclear scintigraphy. Once this is accomplished, the clinician's attention should immediately focus on (1) restoring nutritional status, (2) providing symptomatic relief from nausea and vomiting, and (3) improving gastric motility. These three tasks should be undertaken simultaneously and aggressively with constant reassessment and modification. Any abrupt change in clinical status should prompt diagnostic re-evaluation to rule out causes for symptomatology besides gastroparesis. Figure 31-1 depicts a treatment algorithm that approximates our general approach to treating delayed gastric emptying. Combination therapy is the rule rather than the exception, and most patients require multiple prokinetic and antiemetic modalities for adequate symptom relief. This chapter highlights the following primary goals of treatment in gastroparesis:

1. Restoration of nutrition

2. Prokinetic therapy

3. Antiemetic therapy

4. Incorporating the evolving role of gastric electrical stimulation (GES).

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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