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Severely delayed gastric emptying is moderately common.

Symptoms

  • Upper abdominal discomfort

  • Early satiety

  • Nausea; vomiting (1–3 h after meals)

Common causes

  • Diabetic gastroparesis

  • Post surgery, e.g. vagotomy, fundoplication

  • Idiopathic

Diagnosis

  • Endoscopy → gastric residue

  • Barium swallow + follow through

  • ‘Nuclear’ gastric emptying test

Management

  • Diet—small meals, avoid fats and doughy bread

Consider

  • Motilium, metoclopramide or erythromycin

  • Pyloric injection botulinum toxin

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