Gastroenterology

Gastroenterology

Volume 127, Issue 5, November 2004, Pages 1592-1622
Gastroenterology

American Gastroenterological Association
American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis

https://doi.org/10.1053/j.gastro.2004.09.055Get rights and content

This literature review and the recommendations herein were prepared for the American Gastroenterological Association Clinical Practice Committee. The paper was approved by the Committee on May 16, 2004, and by the AGA Governing Board on September 23, 2004.

Section snippets

Symptoms and clinical presentation of gastroparesis

Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying in the absence of mechanical obstruction. Symptoms of gastroparesis are variable and include early satiety, nausea, vomiting, bloating, and upper abdominal discomfort. In 146 patients with gastroparesis, nausea was present in 92%, vomiting in 84%, abdominal bloating in 75%, and early satiety in 60%.1 Complications of gastroparesis may contribute to patient morbidity and include esophagitis,

Overview of diagnostic approach

Gastroparesis is diagnosed by demonstrating delayed gastric emptying in a symptomatic individual after exclusion of other potential etiologies of symptoms (Table 1). Gastroparesis is often suspected in patient subgroups with specific profiles. Typical symptoms in an individual with long-standing type 1 diabetes mellitus suggest diabetic gastroparesis, whereas similar symptoms in a young woman are consistent with idiopathic gastroparesis. A diagnosis of functional dyspepsia may be entertained if

Disorders with delayed gastric emptying (gastroparesis)

Gastroparesis occurs in many clinical settings; idiopathic, diabetic, and postsurgical etiologies comprise the majority of cases in most series. In one series of 146 patients, gastroparesis was idiopathic in 36%, diabetic in 29%, and postsurgical in 13% of patients.1 Several gastrointestinal and systemic diseases are associated with gastroparesis (Table 4). Selected individual disorders frequently referred to gastroenterologists for evaluation and management are discussed in the following text.

Treatment of symptomatic gastroparesis

The general principles for treatment of symptomatic gastroparesis are to (1) correct fluid, electrolyte, and nutritional deficiencies; (2) identify and rectify the underlying cause of gastroparesis if possible; and (3) reduce symptoms.24 The patient’s medication list should be reviewed to eliminate drugs that might exacerbate the underlying dysmotility disorder or prevent the beneficial actions of a prokinetic agent. Diabetic patients should strive for optimal glycemic control to minimize any

Conclusion

This report has reviewed the diagnosis and treatment of gastroparesis. Several tests are available for the evaluation of patients with suspected gastroparesis. Treatments of gastric dysmotility rely on dietary, pharmacologic, and surgical therapies that relieve symptoms and maintain adequate nutrition. This is an area of active investigation because the current therapy is suboptimal and existing treatments have not been well studied. Evidence-based investigation will be required to better

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