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Review
. 2017 Sep 15;11(5):579-589.
doi: 10.5009/gnl16336.

Gastroparesis Updates on Pathogenesis and Management

Nanlong Liu  1 , Thomas Abell  1
Affiliations
Review

Gastroparesis Updates on Pathogenesis and Management

Nanlong Liu et al. Gut Liver. .

Abstract

Gastroparesis (Gp) is a chronic disease that presents with clinical symptoms of early satiety, bloating, nausea, vomiting, and abdominal pain. Along with these symptoms, an objective finding of delayed gastric emptying, along with a documented absence of gastric outlet obstruction, are required for diagnosis. This article focuses on updates in the pathogenesis and management of Gp. Recent studies on full thickness biopsies of Gp patients have shed light on the complex interactions of the central, autonomic, and enteric nervous systems, which all play key roles in maintaining normal gut motility. The management of Gp has evolved beyond prokinetics and antiemetics with the use of gastric electrical stimulators (GES). In addition, this review aims to introduce the concept of gastroparesis-like syndrome (GLS). GLS helps groups of patients who have the cardinal symptoms of Gp but have a normal or rapid emptying test. Recent tests have shown that patients with Gp and GLS have similar pathophysiology, benefit greatly from GES placement, and likely should be treated in a similar manner.

Keywords: Enteric nervous system; Gastric emptying; Gastroparesis; Nausea; Vomiting.

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Conflict of interest statement

CONFLICTS OF INTEREST

Thomas Abell is a speaker and investigator for Medtronic, is an investigator for Theravance and has IP through the University of Mississippi, now licensed to ADEPT-GI, of which he is the founder. He is also an editor for MedStudy and a reviewer for UpToDate. Nanlong Liu has no conflicts of interest to disclose.

Figures

Fig. 1
Fig. 1
Electron microscopy of the interstitial cells of Cajal (ICC) network in gastric smooth muscle in a chronic unexplained nausea and vomiting (CUNV) patient. (A) Compared with the control (B). Labeled structural components: thick basal lamina (small asterisks), nerve endings (NEs), smooth muscle cells (SMCs), lamellar body (LB), contact between ICC and SMCs (arrows), peg-and-socket junction (large asterisks). Adapted from Angeli TR, et al. Gastroenterology 2015;149:56–66.e5, with permission from Elsevier.
Fig. 2
Fig. 2
Interaction of interstitial cells of Cajal (ICC) cells and neuronal nitric oxide synthase (nNOS) signaling for normal gastric emptying (GE). NO, nitric oxide; Ach, acetylcholine; SMC, smooth muscle cell.
Fig. 3
Fig. 3
Conceptual framework for pathophysiology of gastroparesis syndromes. CNS, central nervous system; ANS, autonomic nervous system; ENS, enteric nervous system; PNS, parasympathetic nervous system; SNS, sympathetic nervous system.
Fig. 4
Fig. 4
Diagnosis and management algorithm for gastroparesis (Gp) syndromes. EGD, esophagogastroduodenoscopy; GES, gastric electrical stimulators.
See this image and copyright information in PMC

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