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Gastroparesis

Nature Reviews Disease Primers volume 4, Article number: 41 (2018) Cite this article

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Abstract

Gastroparesis is a disorder characterized by delayed gastric emptying of solid food in the absence of a mechanical obstruction of the stomach, resulting in the cardinal symptoms of early satiety, postprandial fullness, nausea, vomiting, belching and bloating. Gastroparesis is now recognized as part of a broader spectrum of gastric neuromuscular dysfunction that includes impaired gastric accommodation. The overlap between upper gastrointestinal symptoms makes the distinction between gastroparesis and other disorders, such as functional dyspepsia, challenging. Thus, a confirmed diagnosis of gastroparesis requires measurement of delayed gastric emptying via an appropriate test, such as gastric scintigraphy or breath testing. Gastroparesis can have idiopathic, diabetic, iatrogenic, post-surgical or post-viral aetiologies. The management of gastroparesis involves: correcting fluid, electrolyte and nutritional deficiencies; identifying and treating the cause of delayed gastric emptying (for example, diabetes mellitus); and suppressing or eliminating symptoms with pharmacological agents as first-line therapies. Several novel pharmacologic agents and interventions are currently in the pipeline and show promise to help tailor individualized therapy for patients with gastroparesis.

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Fig. 1: Mechanisms of gastric accommodation and emptying.
Fig. 2: Histological changes in gastroparesis.
Fig. 3: Diagnosis of delayed gastric emptying in gastroparesis.
Fig. 4: Proposed algorithm for treatment-refractory gastroparesis.

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Acknowledgements

The authors thank and acknowledge the excellent secretarial assistance of C. Stanislav, Mayo Clinic.

Reviewer information

Nature Reviews Disease Primers thanks M. Bashashati, K. Bielefeldt, P. Hellström, G. Sanger and the other anonymous referee(s) for their contribution to the peer review of this work.

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Authors and Affiliations

  1. Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA

    Michael Camilleri & Victor Chedid

  2. Leeds Gastroenterology Institute, Leeds Teaching Hospitals NHS Trust, Leeds, UK

    Alexander C. Ford

  3. Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, UK

    Alexander C. Ford

  4. Department of Internal Medicine 2, General Medical Center, Kawasaki Medical School, Okayama, Japan

    Ken Haruma

  5. Endocrine and Metabolic Unit, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    Michael Horowitz

  6. National Health and Medical Research Council of Australia Centre of Research Excellence in Translating Nutritional Science to Good Health, University of Adelaide, Adelaide, South Australia, Australia

    Karen L. Jones

  7. Department of Neurology, Mayo Clinic, Rochester, MN, USA

    Phillip A. Low

  8. Division of Gastroenterology, Chonnam National University School of Medicine, Gwangju, Republic of Korea

    Seon-Young Park

  9. GI Section, Department of Medicine, Temple University School of Medicine, Philadelphia, PA, USA

    Henry P. Parkman

  10. Department of Digestive Diseases, Policlinico S. Orsola-Malpighi, University of Bologna, Bologna, Italy

    Vincenzo Stanghellini

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Contributions

Introduction (M.C.); Epidemiology (M.C. and A.C.F.); Mechanisms/pathophysiology (M.C., V.C., K.H., M.H., K.L.J. and P.A.L.); Diagnosis, screening and prevention (M.C., K.H., K.L.J., S.-Y.P. and V.S.); Management (M.C., V.C. and H.P.P.); Quality of life (M.C. and A.C.F.); Outlook (M.C.); Overview of the Primer (M.C.).

Corresponding author

Correspondence to Michael Camilleri.

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Competing interests

M.C. consults with Allergan on relamorelin (consulting fee to his employer, Mayo Clinic) and consults with Shire on prucalopride (consulting fee to his employer, Mayo Clinic) and has received a research grant from Takeda for study on TAK-954. All other authors declare no noteworthy conflicts of interest.

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Camilleri, M., Chedid, V., Ford, A.C. et al. Gastroparesis. Nat Rev Dis Primers 4, 41 (2018). https://doi.org/10.1038/s41572-018-0038-z

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