Management of Gastroparesis

Ting Zheng, Michael Camilleri

Research output: Contribution to journalArticlepeer-review

Abstract

Gastroparesis is a gastrointestinal motility disorder characterized by nausea, vomiting, early satiation, postprandial fullness, bloating, and upper abdominal pain. The diagnosis requires documented delay in gastric emptying with an optimal test such as scintigraphy or stable isotope gastric emptying breath test in the absence of mechanical obstruction. The pathophysiologic mechanisms of gastroparesis are multifactorial, including antroduodenal hypomotility, pylorospasm, impaired gastric accommodation, and visceral hypersensitivity. The etiologies of gastroparesis are broad, but the most common subtypes are idiopathic, diabetic, and postsurgical. Less frequent etiologies are neurodegenerative disorder (Parkinson disease), myopathies (scleroderma, amyloidosis), and neoplastic syndrome. Symptoms of gastroparesis can be refractory and challenging to manage, leading to reduced quality of life and significant health care expenditure. This article introduces the epidemiology, clinical presentation, diagnosis, and differential diagnoses of gastroparesis, followed by a focused discussion on its management, including nutritional support, prokinetic and antiemetic agents, and emerging interventions directed at the pylorus. Robust sham-controlled trials are needed to evaluate the long-Term efficacy of gastric peroral endoscopic myotomy. A multidisciplinary approach with individualized strategies based on characterization of the pathophysiology is deemed necessary to enhance clinical outcomes.

Original languageEnglish (US)
Pages (from-to)515-525
Number of pages11
JournalGastroenterology and Hepatology
Volume17
Issue number11
StatePublished - Nov 2021

Keywords

  • gastric accommodation
  • Gastric emptying
  • nutritional support
  • prokinetics, gastric peroral endoscopic myotomy
  • visceral hypersensitivity

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology

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