3.2.4.0 Gas­troin­testi­nal Neu­ropathies.

Gas­troin­testi­nal neu­ropathies may in­volve any por­tion of the gas­troin­testi­nal tract with man­i­fes­ta­tions in­clud­ing esophageal dys­motil­i­ty, gas­tro­pare­sis, con­sti­pa­tion, di­ar­rhea, and fecal in­con­ti­nence. Gas­tro­pare­sis should be sus­pect­ed in in­di­vid­u­als with er­rat­ic glycemic con­trol or with upper gas­troin­testi­nal symp­toms with­out an­oth­er iden­tified cause. Ex­clu­sion of or­gan­ic caus­es of gas­tric out­let ob­struc­tion or pep­tic ulcer dis­ease (with esoph­a­gogas­tro­duo­denoscopy or a bar­i­um study of the stom­ach) is need­ed be­fore con­sid­ering a di­ag­no­sis of or spe­cialized test­ing for gas­tro­pare­sis. The di­ag­nos­tic gold stan­dard for gas­tro­pare­sis is the mea­sure­ment of gas­tric emp­ty­ing with scintig­ra­phy of di­gestible solids at 15-min in­ter­vals for 4 h after food in­take. The use of ¹³C oc­tanoic acid breath test is emerg­ing as a vi­able al­ter­na­tive.