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Review
. 2023 Aug 14;13(8):1743.
doi: 10.3390/life13081743.

Imaging in Gastroparesis: Exploring Innovative Diagnostic Approaches, Symptoms, and Treatment

Francesco Vito Mandarino  1 , Sabrina Gloria Giulia Testoni  1 , Alberto Barchi  1 , Francesco Azzolini  1 , Emanuele Sinagra  2 , Gino Pepe  3 , Arturo Chiti  3 , Silvio Danese  1
Affiliations
Review

Imaging in Gastroparesis: Exploring Innovative Diagnostic Approaches, Symptoms, and Treatment

Francesco Vito Mandarino et al. Life (Basel). .

Abstract

Gastroparesis (GP) is a chronic disease characterized by upper gastrointestinal symptoms, primarily nausea and vomiting, and delayed gastric emptying (GE), in the absence of mechanical GI obstruction. The underlying pathophysiology of GP remains unclear, but factors contributing to the condition include vagal nerve dysfunction, impaired gastric fundic accommodation, antral hypomotility, gastric dysrhythmias, and pyloric dysfunction. Currently, gastric emptying scintigraphy (GES) is considered the gold standard for GP diagnosis. However, the overall delay in GE weakly correlates with GP symptoms and their severity. Recent research efforts have focused on developing treatments that address the presumed underlying pathophysiological mechanisms of GP, such as pyloric hypertonicity, with Gastric Peroral Endoscopic Myotomy (G-POEM) one of these procedures. New promising diagnostic tools for gastroparesis include wireless motility capsule (WMC), the 13 carbon-GE breath test, high-resolution electrogastrography, and the Endoluminal Functional Lumen Imaging Probe (EndoFLIP). Some of these tools assess alterations beyond GE, such as muscular electrical activity and pyloric tone. These modalities have the potential to characterize the pathophysiology of gastroparesis, identifying patients who may benefit from targeted therapies. The aim of this review is to provide an overview of the current knowledge on diagnostic pathways in GP, with a focus on the association between diagnosis, symptoms, and treatment.

Keywords: functional dyspepsia; gastric emptying study; gastroparesis; scintigraphy.

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Conflict of interest statement

S.D. has served as a speaker, consultant, and advisory board member for Schering-Plough, AbbVie, Actelion, Alphawasserman, AstraZeneca, Cellerix, Cosmo Pharmaceuticals, Ferring, Genentech, Grunenthal, Johnson and Johnson, Millenium Takeda, MSD, Nikkiso Europe GmbH, Novo Nordisk, Nycomed, Pfizer, Pharmacosmos, UCB Pharma, and Vifor. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Output of gastric emptying scintigraphy (GES) of a diabetic gastroparesis with primarily antrum dysmotility (intragastric meal distribution of 89%). Anterior rendering at 0 min (A0), 30 min (A1), 60 min (A2), 90 min (A3), 120 min (A4), 180 min (A5), and 240 min (A6) after labelled meal ingestion. Posterior rendering at 0 min (P0), 30 min (P1), 60 min (P2), 90 min (P3), 120 min (P4), 180 min (P5), and 240 min (P6) after labelled meal ingestion. The copyrights of the pictures belong to the authors.
Figure 2
Figure 2
Progressive steps of Gastric Peroral Endoscopic Myotomy (G-POEM): (A) the initial lifting by submucosal injection; (B) the opening of the tunnel through progressive submucosal dissection; (C) the initiation of myotomy from the muscle fibers of the pylorus; (D) the completion of full-thickness myotomy. The copyrights of the pictures belong to the authors.
See this image and copyright information in PMC

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