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Gastroparesis

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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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.).

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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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