Gastroparesis in the Setting of Pancreatitis

Brenda from Houston sent us this question: “I recently had an ERCP with stenting since the doctors were suspecting that I had stones in my bile duct. The day after I have a gallbladder surgery. Immediately after, I developed post ERCP pancreatitis. Now, almost 6 weeks after, the pancreas has resolved but I was left with a chronic nausea and sudden pains. My GI performed a gastric emptying study and it came back abnormal. Now, I am showing symptoms of gastroparesis. My doctor is confident that this can be changed by diet modification which I have done and that this is only temporary, but the nausea is there all the time, I get bloated and I get full easily. Medications are losing their effect. Is it common to exhibit signs of gastroparesis after gallbladder surgery and does it actually correct with time? What options do I have?”

Dear Brenda,

Gastroparesis and gallbladder surgery are not related. Gastroparesis, gallbladder disease and pancreatitis, on the other hand, share a number of symptoms including abdominal pain, nausea and vomiting. If ERCP did not show common bile duct stones, your symptoms were most likely secondary to pre-existing gastroparesis. If ERCP was positive for stones, pancreatitis may cause gastroparesis that is typically transient in nature and tend to improve with time. Complicated pancreatitis with pseudocyst formation may result in gastric outlet obstruction. In this situation, pseudocyst drainage is indicated to alleviate symptoms.

First step management for gastroparesis relies on dietary changes (small frequent meals), along with pro-motility and anti-emetic medications. There are a number of pro-motility medications available on the market. If you fail medical treatment and lifestyle changes, a number of procedures may be considered for treatment of gastroparesis. We have discussed these treatment options in a number of previous blogs.