Differential diagnosis of gastroparesis
| Disorder | Clinical presentation and differentiation from gastroparesis | Treatment |
|---|---|---|
| Functional dyspepsia | Less nausea and vomiting Often indistinguishable | Helicobacter pylori eradication, proton pump inhibitors, tricyclic antidepressants, prokinetics, consider psychotherapy29 |
| Rumination syndrome | Effortless and repetitive regurgitation of ingested food | Behavioral modification: deep-breathing exercises, diaphragmatic breathing |
| Cyclic vomiting syndrome | Absence of symptoms between vomiting episodes Compulsive hot bathing or showering Strong association with personal or family history of migraines | Acute attacks: ondansetron, triptans, aprepitant Prophylaxis: tricyclic antidepressant, topiramate, aprepitant, zonisamide, levetiracetam |
| Cannabinoid hyperemesis syndrome | Absence of symptoms between vomiting episodes Compulsive hot bathing or showering Cannabis use Gastric emptying scintigraphy might be normal | Benzodiazepines, tricyclic antidepressants, haloperidol, droperidol, promethazine, prochlorperazine, ondansetron, corticosteroids, capsaicin Cannabis cessation |
| Anorexia or bulimia | Binge and purge behavior (bulimia), and severe caloric restriction (anorexia) | Psychotherapy, selective serotonin reuptake inhibitors |
| Anxiety disorder toward food (avoidant restrictive food intake disorder) | Immediate postprandial nausea and vomiting when patients see the food or put it in their mouth | Cognitive behavioral therapy, cyproheptadine |
| Narcotic bowel syndrome | Chronic or intermittent colicky abdominal pain that worsens when the narcotic effect wears off Constipation is common | Clonidine, benzodiazepines, tricyclic antidepressants, serotonin-norepinephrine reuptake inhibitors, laxatives, methylnaltrexone |
Based on information from references 30–32.