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Gastroparesis: pathogenesis, diagnosis and management

Abstract

Gastroparesis is a prevalent condition that produces symptoms of delayed gastric emptying in the absence of physical blockage. The most common etiologies of gastroparesis are idiopathic, diabetic, and postsurgical disease, although some cases stem from autoimmune, paraneoplastic, neurologic or other conditions. Histologic examination of gastric tissues from patients with severe gastroparesis reveals heterogeneous and inconsistent defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal, and increased levels of inflammatory cells. Diagnosis is most commonly made by gastric emptying scintigraphy; however, wireless motility capsules and nonradioactive isotope breath tests have also been validated. A range of treatments have been used for gastroparesis including dietary modifications and nutritional supplements, gastric motor stimulatory or antiemetic medications, endoscopic or surgical procedures, and psychological interventions. Most treatments have not been subjected to controlled testing in patients with gastroparesis. The natural history of this condition is poorly understood. Active ongoing research is providing important insights into the pathogenesis, diagnosis, treatment and outcomes of this disease.

Key Points

  • Gastroparesis causes chronic symptoms of delayed gastric emptying; it can promote extraintestinal complications, and it leads to significant morbidity and health-care utilization

  • Diabetic, idiopathic and postsurgical gastroparesis are the most common etiologies of disease

  • Histopathology reveals defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal; in addition, the loss of neurotransmitters and increased levels of inflammatory cells suggests a heterogeneous pathogenesis of disease

  • Techniques to measure gastric emptying, including gastric emptying scintigraphy, wireless motility capsule monitoring and breath tests, are being validated for the diagnosis of gastroparesis but controversies persist

  • Treatments for gastroparesis include prokinetic and antiemetic drugs, endoscopic and surgical techniques, and nutritional and psychologic interventions; however, controlled testing is still needed to confirm their benefits

  • Ongoing research is defining the natural history of gastroparesis

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Figure 1: Gastric emptying scintigraphy results from healthy individuals after the consumption a radiolabeled low-fat egg-substitute meal.
Figure 2: The relationships between gastric emptying of a radiolabeled egg-substitute meal (purple) and a wireless motility capsule (WMC) (green).
Figure 3: Changes in nausea and/or vomiting Gastroparesis Cardinal Symptom Index (GCSI) subscale scores in patients with diabetes and severe gastroparesis following the intravenous administration of the ghrelin agonist TZP-101 (also known as ulimorelin).
Figure 4: Vomiting frequency in patients with diabetic gastroparesis after implantation of a gastric electrical stimulator device.

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Acknowledgements

W. L. Hasler receives funding from grant 1 U01 DK073985-01 from the NIH. C. P. Vega, University of California, Irvine, CA, is the author of and is solely responsible for the content of the learning objectives, questions and answers of the Medscape, LLC-accredited continuing medical education activity associated with this article.

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W. L. Hasler serves as a Consultant for SmartPill Corporation.

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Hasler, W. Gastroparesis: pathogenesis, diagnosis and management. Nat Rev Gastroenterol Hepatol 8, 438–453 (2011). https://doi.org/10.1038/nrgastro.2011.116

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