From the Guidelines
Paraneoplastic gastroparesis is a rare but documented complication of cancer, with several real case studies in medical literature, and treatment typically involves addressing the underlying malignancy while managing gastroparesis symptoms with prokinetics like metoclopramide or domperidone, as well as immunomodulatory therapy and nutritional support 1.
Definition and Diagnosis
Paraneoplastic gastroparesis can be defined as persistent symptoms in the context of objectively confirmed gastric emptying delay, despite the use of dietary adjustment and metoclopramide as a first-line therapeutic agent, and is often associated with cancer, particularly small cell lung cancer, pancreatic adenocarcinoma, and ovarian cancer 1.
Treatment Options
Treatment of paraneoplastic gastroparesis typically involves addressing the underlying malignancy through surgery, chemotherapy, or radiation, while managing gastroparesis symptoms with prokinetics like metoclopramide (10mg three times daily before meals) or domperidone (10-20mg three to four times daily) 1.
- Immunomodulatory therapy with corticosteroids (prednisone 1mg/kg/day), intravenous immunoglobulin (2g/kg over 5 days), or plasma exchange may help in antibody-mediated cases 1.
- Nutritional support is crucial, potentially requiring jejunal feeding tubes for severe cases.
Clinical Presentation
These syndromes occur when cancer triggers an autoimmune response against antigens shared by tumor cells and the gastrointestinal nervous system, leading to impaired gastric motility, and patients often present with nausea, vomiting, and abdominal pain 1.
Recent Studies
Recent studies have shown that gastric peroral endoscopic myotomy (G-POEM) may be a promising minimally invasive option for severe gastroparesis, particularly in patients with primarily nausea and vomiting, and a Gastroparesis Cardinal Symptom Index (GCSI) total score >2 1.
From the Research
Paraneoplastic Syndromes Manifesting as Gastroparesis
- Paraneoplastic gastroparesis is a rare clinical entity that can precede the detection of an overt cancer, with nonspecific gastrointestinal symptoms such as intractable vomiting and abdominal discomfort 2, 3.
- The pathophysiology of paraneoplastic gastroparesis involves an autoimmune destruction of the nerve plexus of the stomach, which can be associated with anti-neuronal nuclear antibodies type 1 (Anti-Hu) and cytoplasmic purkinje cell antibodies (Anti-Yo) 2, 4.
- Diagnosis of paraneoplastic gastroparesis can be challenging, but serological testing for anti-Hu antibodies and imaging studies such as computed tomography (CT) scan and positron emission tomography (PET) scan can aid in the diagnosis 2, 4.
- Treatment of paraneoplastic gastroparesis typically involves a combination of chemotherapy, dietary modifications, pro-kinetic agents, and psychological counseling, with the goal of managing symptoms and improving quality of life 2, 4.
Case Studies
- A 61-year-old African-American man presented with severe gastroparesis that was later proven to be associated with an occult poorly differentiated non-small cell lung cancer, highlighting the importance of considering paraneoplastic syndromes in patients with unexplained gastrointestinal symptoms 2.
- A 70-year-old Caucasian female presented with severe gastroparesis that was later proven to be associated with an overt small cell lung cancer, demonstrating the need for clinicians to be aware of this rare clinical entity 3.
- A patient with severe gastroparesis was found to have high titres of anti-Hu antibodies and was diagnosed with small-cell lung cancer, emphasizing the importance of serological testing in the diagnosis of paraneoplastic syndromes 4.
Clinical Significance
- Paraneoplastic syndromes affect 10% to 15% of cancer patients and can appear before, after, or simultaneously with a cancer diagnosis, making it essential for clinicians to be aware of these conditions 5, 6.
- The diagnostic and therapeutic approaches for paraneoplastic syndromes are heterogeneous and require a multidisciplinary approach, with recent advances focusing on diagnostic tools and therapeutic options 5, 6.