Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Review Article
  • Published:

New management approaches for gastroparesis

Nature Clinical Practice Gastroenterology & Hepatology volume 2, pages 454–462 (2005)Cite this article

Abstract

Management of patients with gastroparesis is challenging. Although the syndrome has multiple causes and knowledge of the pathophysiology and natural history is far from complete, a number of common management principles can be applied. The relatively poor correlation between upper-gastrointestinal symptoms and disordered gastric emptying represents a major difficulty in the therapeutic approach, and evidence to support the efficacy of current management strategies is often suboptimal, especially in relation to long-term therapy. In this review, the common causes and pathophysiology of gastroparesis are summarized, the diagnostic approach considered, and the evidence to support medical and surgical therapies reviewed. These therapies include currently available prokinetic drugs, novel medical therapies, and the promising technique of gastric electrical stimulation.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1: Motor events during normal gastric emptying.

Similar content being viewed by others

References

  1. Jones MP and Maganti K (2003) A systematic review of surgical therapy for gastroparesis. Am J Gastroenterol 98: 2122–2129

    Article  Google Scholar 

  2. Soykan I et al. (1998) Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci 43: 2398–2404

    Article  CAS  Google Scholar 

  3. Talley NJ (2003) Diabetic gastropathy and prokinetics. Am J Gastroenterol 98: 264–271

    Article  Google Scholar 

  4. Tack J and Lee KJ (2005) Pathophysiology and treatment of functional dyspepsia. J Clin Gastroenterol 39 (Suppl): S211–S216

    Article  Google Scholar 

  5. Jones KL et al. (2001) Predictors of delayed gastric emptying in diabetes. Diabetes Care 24: 1264–1269

    Article  CAS  Google Scholar 

  6. Horowitz M et al. (1991) Relationships between oesophageal transit and solid and liquid gastric emptying in diabetes mellitus. Eur J Nucl Med 18: 229–234

    Article  CAS  Google Scholar 

  7. Parkman HP et al. (2004) American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology 127: 1592–1622

    Article  Google Scholar 

  8. O'Donovan D et al. (2003) Idiopathic and Diabetic Gastroparesis. Curr Treat Options Gastroenterol 6: 299–309

    Article  Google Scholar 

  9. Ritz MA et al. (2000) Impacts and patterns of disturbed gastrointestinal function in critically ill patients. Am J Gastroenterol 95: 3044–3052

    Article  CAS  Google Scholar 

  10. Horowitz M et al. (1994) Role and integration of mechanisms controlling gastric emptying. Dig Dis Sci 39 (Suppl): 7S–13S

    Article  CAS  Google Scholar 

  11. Horowitz M et al. (2002) Gastric emptying in diabetes: clinical significance and treatment. Diabet Med 19: 177–194

    Article  CAS  Google Scholar 

  12. Mearin F et al. (1986) Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology 90: 1919–1925

    Article  CAS  Google Scholar 

  13. Fraser R et al. (1993) Organization of antral, pyloric and duodenal motility in patients with gastroparesis. J Gastrointest Mot 5: 167–175

    Article  Google Scholar 

  14. Rayner CK et al. (2001) Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diabetes Care 24: 371–381

    Article  CAS  Google Scholar 

  15. Lee KJ et al. (2004) Pathophysiology of functional dyspepsia. Best Pract Res Clin Gastroenterol 18: 707–716

    Article  CAS  Google Scholar 

  16. Tack J et al. (1998) Role of impaired gastric accommodation to a meal in functional dyspepsia. Gastroenterology 115: 1346–1352

    Article  CAS  Google Scholar 

  17. Azpiroz F and Malagelada JR (1987) Gastric tone measured by an electronic barostat in health and postsurgical gastroparesis. Gastroenterology 92: 934–943

    Article  CAS  Google Scholar 

  18. Malagelada JR et al. (1980) Gastric motor abnormalities in diabetic and postvagotomy gastroparesis: effect of metoclopramide and bethanechol. Gastroenterology 78: 286–293

    CAS  PubMed  Google Scholar 

  19. Camilleri M et al. (1998) Measurement of gastrointestinal motility in the GI laboratory. Gastroenterology 115: 747–762

    Article  CAS  Google Scholar 

  20. Wright RA et al. (1985) Diabetic gastroparesis: an abnormality of gastric emptying of solids. Am J Med Sci 289: 240–242

    Article  CAS  Google Scholar 

  21. Tougas G et al. (2000) Standardization of a simplified scintigraphic methodology for the assessment of gastric emptying in a multicenter setting. Am J Gastroenterol 95: 78–86

    Article  CAS  Google Scholar 

  22. De Schepper HU et al. (2004) Assessment of gastric accommodation: overview and evaluation of current methods. Neurogastroenterol Motil 16: 275–285

    Article  CAS  Google Scholar 

  23. Parkman HP et al. (2003) Electrogastrography: a document prepared by the gastric section of the American Motility Society Clinical GI Motility Testing Task Force. Neurogastroenterol Motil 15: 89–102

    Article  CAS  Google Scholar 

  24. Koch KL et al. (1989) Gastric emptying and gastric myoelectrical activity in patients with diabetic gastroparesis: effect of long-term domperidone treatment. Am J Gastroenterol 84: 1069–1075

    CAS  PubMed  Google Scholar 

  25. Horowitz M et al. (2001) Gastroparesis: prevalence, clinical significance and treatment. Can J Gastroenterol 15: 805–813

    Article  CAS  Google Scholar 

  26. Jones KL et al. (1999) Hyperglycemia attenuates the gastrokinetic effect of erythromycin and affects the perception of postprandial hunger in normal subjects. Diabetes Care 22: 339–344

    Article  CAS  Google Scholar 

  27. DiBaise JK et al. (2001) Effects of low doses of erythromycin on the 13C Spirulina platensis gastric emptying breath test and electrogastrogram: a controlled study in healthy volunteers. Am J Gastroenterol 96: 2041–2050

    Article  CAS  Google Scholar 

  28. Fraser R et al. (1993) Dual effects of cisapride on gastric emptying and antropyloroduodenal motility. Am J Physiol 264: G195–G201

    CAS  PubMed  Google Scholar 

  29. Ishii M et al. (1997) Erythromycin derivative improves gastric emptying and insulin requirement in diabetic patients with gastroparesis. Diabetes Care 20: 1134–1137

    Article  CAS  Google Scholar 

  30. Tatsuta M et al. (1992) Effect of treatment with cisapride alone or in combination with domperidone on gastric emptying and gastrointestinal symptoms in dyspeptic patients. Aliment Pharmacol Ther 6: 221–228

    Article  CAS  Google Scholar 

  31. Janssens J et al. (1990) Improvement in gastric emptying in diabetic gastroparesis by erythromycin. N Engl J Med 322: 1028–1031

    Article  CAS  Google Scholar 

  32. Arts J et al. (2005) Influence of erythromycin on gastric emptying and meal related symptoms in functional dyspepsia with delayed gastric emptying. Gut 54: 455–460

    Article  CAS  Google Scholar 

  33. Dhir R and Richter JE (2004) Erythromycin in the short- and long-term control of dyspepsia symptoms in patients with gastroparesis. J Clin Gastroenterol 38: 237–242

    Article  CAS  Google Scholar 

  34. Edelbroek MA et al. (1993) Effects of erythromycin on gastric emptying, alcohol absorption and small intestinal transit in normal subjects. J Nucl Med 34: 582–588

    CAS  PubMed  Google Scholar 

  35. Talley NJ et al. (2001) Effects of a motilin receptor agonist (ABT-229) on upper gastrointestinal symptoms in type 1 diabetes mellitus: a randomised, double blind, placebo controlled trial. Gut 49: 395–401

    Article  CAS  Google Scholar 

  36. Talley NJ et al. (2000) Failure of a motilin receptor agonist (ABT-229) to relieve the symptoms of functional dyspepsia in patients with and without delayed gastric emptying: a randomized double-blind placebo-controlled trial. Aliment Pharmacol Ther 14: 1653–1661

    Article  CAS  Google Scholar 

  37. Russo A et al. (2004) Effect of the motilin agonist KC 11458 on gastric emptying in diabetic gastroparesis. Aliment Pharmacol Ther 20: 333–338

    Article  CAS  Google Scholar 

  38. Abell TL et al. (1991) Long-term efficacy of oral cisapride in symptomatic upper gut dysmotility. Dig Dis Sci 36: 616–620

    Article  CAS  Google Scholar 

  39. Veysey MJ et al. (2001) Effects of cisapride on gall bladder emptying, intestinal transit, and serum deoxycholate: a prospective, randomised, double blind, placebo controlled trial. Gut 49: 828–834

    Article  CAS  Google Scholar 

  40. Tonini M et al. (1999) Review article: cardiac adverse effects of gastrointestinal prokinetics. Aliment Pharmacol Ther 13: 1585–1591

    Article  CAS  Google Scholar 

  41. McHugh S et al. (1992) Cisapride vs metoclopramide. An acute study in diabetic gastroparesis. Dig Dis Sci 37: 997–1001

    Article  CAS  Google Scholar 

  42. Loo FD et al. (1984) Gastric emptying in patients with diabetes mellitus. Gastroenterology 86: 485–494

    CAS  PubMed  Google Scholar 

  43. Ganzini L et al. (1993) The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders. Arch Intern Med 153: 1469–1475

    Article  CAS  Google Scholar 

  44. Shaffer D et al. (2004) Tardive dyskinesia risks and metoclopramide use before and after U.S. market withdrawal of cisapride. J Am Pharm Assoc (Wash DC) 44: 661–665

    Article  Google Scholar 

  45. Soykan I et al. (1997) The effect of chronic oral domperidone therapy on gastrointestinal symptoms, gastric emptying, and quality of life in patients with gastroparesis. Am J Gastroenterol 92: 976–980

    CAS  PubMed  Google Scholar 

  46. Farup CE et al. (1998) Effect of domperidone on the health-related quality of life of patients with symptoms of diabetic gastroparesis. Diabetes Care 21: 1699–1706

    Article  CAS  Google Scholar 

  47. Melga P et al. (1997) Chronic administration of levosulpiride and glycemic control in IDDM patients with gastroparesis. Diabetes Care 20: 55–58

    Article  CAS  Google Scholar 

  48. Murray CD et al. (2005) Ghrelin enhances gastric emptying in diabetic gastroparesis: a double-blind, placebo-controlled, cross-over study. Gut [10.1136/gut.2005.069088]

  49. Rabine JC and Barnett JL (2001) Management of the patient with gastroparesis. J Clin Gastroenterol 32: 11–18

    Article  CAS  Google Scholar 

  50. Thumshirn M et al. (1999) Modulation of gastric sensory and motor functions by nitrergic and alpha-2-adrenergic agents in humans. Gastroenterology 116: 573–585

    Article  CAS  Google Scholar 

  51. Dishy V et al. (2004) The effect of sildenafil on gastric emptying in patients with end-stage renal failure and symptoms of gastroparesis. Clin Pharmacol Ther 76: 281–286

    Article  CAS  Google Scholar 

  52. Jones KL et al. (2000) Effects of fedotozine on gastric emptying and upper gastrointestinal symptoms in diabetic gastroparesis. Aliment Pharmacol Ther 14: 937–943

    Article  CAS  Google Scholar 

  53. Clouse RE (2003) Managing functional bowel disorders from the top down: lessons from a well-designed treatment trial. Gastroenterology 125: 249–253

    Article  Google Scholar 

  54. Lacy BE et al. (2002) Botulinum toxin for the treatment of gastroparesis: a preliminary report. Am J Gastroenterol 97: 1548–1552

    Article  CAS  Google Scholar 

  55. Miller LS et al. (2002) Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle. Am J Gastroenterol 97: 1653–1660

    Article  CAS  Google Scholar 

  56. McCallum RW et al. (1998) Gastric pacing improves emptying and symptoms in patients with gastroparesis. Gastroenterology 114: 456–461

    Article  CAS  Google Scholar 

  57. Lin Z et al. (2004) Treatment of diabetic gastroparesis by high-frequency gastric electrical stimulation. Diabetes Care 27: 1071–1076

    Article  Google Scholar 

  58. Abell T et al. (2003) Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 125: 421–428

    Article  Google Scholar 

  59. Abell T et al. (2003) Gastric electrical stimulation for gastroparesis improves nutritional parameters at short, intermediate, and long-term follow-up. JPEN J Parenter Enteral Nutr 27: 277–281

    Article  Google Scholar 

  60. McCallum R et al. (2005) Clinical response to gastric electrical stimulation in patients with postsurgical gastroparesis. Clin Gastroenterol Hepatol 3: 49–54

    Article  Google Scholar 

  61. Cutts TF et al. (2005) Is gastric electrical stimulation superior to standard pharmacologic therapy in improving GI symptoms, healthcare resources, and long-term health care benefits? Neurogastroenterol Motil 17: 35–43

    Article  CAS  Google Scholar 

  62. Ayinala S et al. (2005) Temporary gastric electrical stimulation with orally or PEG-placed electrodes in patients with drug refractory gastroparesis. Gastrointest Endosc 61: 455–461

    Article  Google Scholar 

  63. Mintchev MP et al. (2000) Microprocessor-controlled movement of solid gastric content using sequential neural electrical stimulation. Gastroenterology 118: 258–263

    Article  CAS  Google Scholar 

  64. Kim CH and Nelson DK (1998) Venting percutaneous gastrostomy in the treatment of refractory idiopathic gastroparesis. Gastrointest Endosc 47: 67–70

    Article  CAS  Google Scholar 

  65. Ejskjaer NT et al. (1999) Novel surgical treatment and gastric pathology in diabetic gastroparesis. Diabet Med 16: 488–495

    Article  CAS  Google Scholar 

  66. Watkins PJ et al. (2003) Long-term outcome after gastrectomy for intractable diabetic gastroparesis. Diabet Med 20: 58–63

    Article  CAS  Google Scholar 

  67. Yamashita S et al. (2000) Longer-term diabetic patients have a more frequent incidence of nosocomial infections after elective gastrectomy. Anesth Analg 91: 1176–1181

    CAS  PubMed  Google Scholar 

  68. Eckhauser FE et al. (1998) Safety and long-term durability of completion gastrectomy in 81 patients with postsurgical gastroparesis syndrome. Am Surg 64 711–717

    CAS  PubMed  Google Scholar 

  69. Forstner-Barthell AW et al. (1999) Near-total completion gastrectomy for severe postvagotomy gastric stasis: analysis of early and long-term results in 62 patients. J Gastrointest Surg 3: 15–23

    Article  CAS  Google Scholar 

  70. Gaber AO et al. (1991) Changes in gastric emptying in recipients of successful combined pancreas-kidney transplants. Dig Dis 9: 437–443

    Article  CAS  Google Scholar 

  71. Kong MF et al. (1999) Natural history of diabetic gastroparesis. Diabetes Care 22: 503–507

    Article  CAS  Google Scholar 

  72. Jones KL et al. (2002) A longitudinal study of gastric emptying and upper gastrointestinal symptoms in patients with diabetes mellitus. Am J Med 113: 449–455

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Gwendolyn Michell Senior Lecturer University of Adelaide Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia

    Christopher K Rayner

  2. Professor of Medicine at the University of Adelaide Department of Medicine, Royal Adelaide Hospital, Adelaide, Australia

    Michael Horowitz

Authors
  1. Christopher K Rayner
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Michael Horowitz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Christopher K Rayner.

Ethics declarations

Competing interests

The authors are currently conducting a study involving prokinetic therapy for Axcan Pharmaceuticals.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Rayner, C., Horowitz, M. New management approaches for gastroparesis. Nat Rev Gastroenterol Hepatol 2, 454–462 (2005). https://doi.org/10.1038/ncpgasthep0283

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncpgasthep0283

This article is cited by

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing