Chapter 16 - Abdominal pain in gastroparesis

Abstract

Abdominal pain is one of the most common gastrointestinal symptoms. Although the differential diagnosis of chronic upper abdominal pain can include gastroparesis, generally one looks for other causes of abdominal pain in a patient with gastroparesis. Nevertheless, abdominal pain is an underrecognized symptom of gastroparesis, affecting many of these patients. Idiopathic and postsurgical etiologies are associated with higher severity of abdominal pain than in diabetic gastroparesis. Abdominal pain in gastroparesis patients is associated with poor quality of life. Some of these patients may be taking opioids which can exacerbate the gastroparesis and even the abdominal pain. The etiology of abdominal pain in gastroparesis may be multifactorial with neuropathic and/or nociceptive components. In addition, patients with gastroparesis can have abdominal pain unrelated to their gastroparesis. On physical examination, Carnett’s sign may be useful in characterizing somatic abdominal wall pain. Determining the underlying cause of abdominal pain in gastroparesis patients may help direct appropriate treatment strategies. The abdominal pain in gastroparesis is more difficult to control than other gastroparesis symptoms such as nausea, vomiting, early satiety, and fullness. Generally, the gastroparesis is treated with prokinetic and antiemetic agents. If pain is still present, then neuromodulators are often used. Although surgical options for gastroparesis (gastric electric stimulation or pyloromyotomy/pyloroplasty) may improve many of the typical gastroparesis symptoms, surgery often does not affect the abdominal pain.