Gastroparesis: A Comprehensive Review

Introduction and physiology

Gastroparesis (GP) is defined as a symptomatic, abnormally slow gastric emptying in the absence of a mechanical obstruction. Delayed gastric emptying was first noted in diabetes and reported by Boas in 1925. In 1958, Kassander et al used the term “gastroparesis diabeticorum” in asymptomatic patients with abnormal retention of barium. Since those days, our advancement in knowledge about the pathophysiology of GP is considerable, though many gaps are still evident.

Abstract

Gastroparesis (GP) is a multifactorial syndrome in which the predominant symptoms of abdominal pain, nausea, bloating, and early satiety occur in the face of an abnormally slow gastric emptying in the absence of a mechanical obstruction. It is most commonly idiopathic or associated with Diabetes Mellitus (DM). There is a 4:1 female to male preponderance, presumably due at least partially to hormonal causes. The differential diagnosis includes metabolic diseases, surgically- and drug-associated GP. There is a considerable overlap with postprandial distress syndrome, a distinct clinical entity that shares several of the symptoms and can be associated with decreased gastric emptying. The treatment for GP is very different in the acute and chronic settings. Acutely, replacement and correction of electrolyte, metabolic and fluid imbalances, and pain and nausea control are key elements. The chronic phase includes diet and lifestyle changes, avoidance of drugs that interfere with motility, use of gastric emptying-enhancing drugs, and careful use of analgesics and antinausea medication. In resistant and selected cases, gastric electrical stimulation may be considered. Several new drugs including newer 5HT4 agonists and Grhelin are being evaluated for future clinical use.

Keywords

Gastroparesis, adults, children, treatment, scintigram, wireless motility capsule