Why might an otherwise healthy teenage boy develop gastroparesis?

From the Guidelines

Gastroparesis in an otherwise healthy teenage boy is most likely to develop from post-viral causes, with viral infections being a common trigger, and treatment should focus on managing symptoms with medications such as metoclopramide and ondansetron, as well as dietary modifications. The exact cause of gastroparesis can be difficult to determine, but potential triggers include viral infections, diabetes, certain medications, psychological factors, and rare conditions such as autoimmune disorders or neurological conditions 1.

Potential Causes of Gastroparesis

• Viral infections: Post-viral gastroparesis often follows a viral illness that damages the vagus nerve or disrupts normal stomach muscle function
• Diabetes: High blood glucose can impair gastric emptying, even in the early stages of the disease
• Medications: Opioids, anticholinergics, and some antidepressants can slow stomach motility
• Psychological factors: Anxiety, depression, and eating disorders may contribute to gastroparesis symptoms in adolescents
• Rare causes: Autoimmune conditions, connective tissue disorders, or neurological conditions

Treatment Options

• Dietary modifications: Small, frequent, low-fat, low-fiber meals can help manage symptoms
• Prokinetic medications: Metoclopramide (10mg before meals, maximum 12 weeks due to side effect risks) or erythromycin (250mg before meals) can help accelerate gastric emptying
• Antiemetics: Ondansetron (4-8mg every 8 hours as needed) can help manage nausea and vomiting, as outlined in the treatment options for refractory gastroparesis symptoms 1
• Other medications: Ginger, aprepitant, and scopolamine may also be considered for symptom management, although their effectiveness and potential side effects should be carefully evaluated 1

Further Evaluation and Management

If gastroparesis persists beyond a few months, further evaluation by a gastroenterologist is warranted to rule out underlying conditions and consider additional treatment options, such as gastric electrical stimulation or enteral feeding 1.

From the Research

Possible Causes of Gastroparesis in a Healthy Teenage Boy

• Idiopathic gastroparesis, which accounts for nearly 50% of cases, may be a possible cause 2
• Postinfectious process, which is likely represented in many idiopathic cases, could be another reason 2
• Medications, such as opioids, can cause gastroparesis, and opiate use has been associated with an increased degree of delayed gastric emptying 3
• Connective tissue disorders, autoimmune disorders, and prior gastric surgery are other potential causes, although these may be less likely in an otherwise healthy teenage boy 2

Diagnosis and Symptoms

• Characteristic symptoms of gastroparesis include nausea, vomiting, epigastric pain, early satiety, and weight loss 2
• Diagnosis is made using a combination of characteristic symptoms and objective evidence of delayed gastric emptying in the absence of mechanical obstruction 2
• Gastric emptying scintigraphy of a radiolabeled solid meal is considered the golden standard for assessing delayed gastric emptying 4

Treatment Options

• Dietary modification, medications to accelerate gastric emptying, antiemetic agents, gastric electrical stimulation, and surgery are possible treatment options 2
• Medications such as metoclopramide, domperidone, and cisapride have been shown to be effective in managing gastroparesis 5
• A stepwise management approach is recommended to optimize outcomes in children with gastroparesis 4