Early postprandial fullness

Specialty: Gastrointestinal.

• Early satiety
• inability to finish a normal meal
• early satiety

Why it occurs

• Diabetic or idiopathic gastroparesis due to non-obstructive neuromuscular dysfunction of gastric emptying
• Gastric cancer or neoplasia of the antrum or pylorus that generates partial obstruction of the gastric outlet
• Functional dyspepsia (postprandial distress syndrome according to Rome IV)
• Extrinsic gastric compression due to giant splenomegaly, retroperitoneal masses or pancreatic pseudocysts
• Obstruction of the gastric outlet tract secondary to pyloric stenosis due to healing of a chronic duodenal ulcer.

Initial workup

Upper gastrointestinal endoscopy (EDA, priority to rule out luminal neoplasms and obstructive strictures) | Gastric emptying scan with Technetium-99m labeled solids (4-hour gold standard) | CT of the abdomen and pelvis with oral and intravenous contrast to rule out compressive extrinsic masses | Blood analysis: complete blood count, iron profile, albumin, prealbumin, electrolytes and kidney function.

Standard management

• First line prokinetics — metoclopramide 5-10 mg three times a day before meals, with caution to limit short-term use due to risk of extrapyramidal effects and long QTc interval; or domperidone 10 mg three times a day with prior ECG monitoring; or erythromycin 50-125 mg as a motilin receptor agonist
• Tricyclic antidepressants at low doses — amitriptyline 10-25 mg at night to modulate gastric visceral hypersensitivity in functional dyspepsia
• Modulators of gastric accommodation (buspirone 10 mg three times a day before meals to relax the gastric fundus).