Gastroparesis: Current diagnostic challenges and management considerations

Table 1 Causes of gastroparesis

Causes
Idiopathic	Medications: opiates, anticholinergics, β-adrenergics, Ca-channel blockers, glucagon, THC, alcohol, tobacco, etc
Surgical causes	Vagotomy and gastric resection/drainage
	Fundoplication, esophagectomy
	Gastric bypass surgery
	Whipple procedure
	Heart/lung transplant
Infections	Viruses-EBV, varicella, parvovirus-like
	Chagas disease
	Clostridium Botulinum
Central nervous system disorders	Cerebrovascular accidents/trauma
	Tumors
	Labyrinthine disorders
	Seizures
Peripheral nervous system disorders	Parkinson's disease
	Guillain-Barre
	Multiple sclerosis
	Dysautonomias
Neuropsychiatric disorders	Anorexia nervosa/bulimia
	Rumination syndrome
Rheumatologic disease	Scleroderma
	Systemic lupus erythematosus
	Polymyositis/dermatomyositis
Endocrine and metabolism diseases	Diabetes
	Hypothyroidism
	Parathyroid disease
	Electrolyte disorders
	Renal failure
	Pregnancy
	Neoplastic(para)-breast, small cell lung, pancreas
Misc. neuromuscular diseases	Amyloidosis
	Chronic intestinal pseudoobstruction
	Myotonic dystrophy

Table 2 Proposed classification of gastroparesis severity

Classification
Grade 1: Mild gastroparesis	Symptoms relatively easily controlled
	Able to maintain weight and nutrition on a regular diet or minor dietary modifications
Grade 2: Compensated gastroparesis	Moderate symptoms with partial control with pharmacological agents
	Able to maintain nutrition with dietary and lifestyle adjustments
	Rare hospital admissions
Grade 3: Severe gastroparesis	Refractory symptoms despite medical therapy
	Inability to maintain nutrition via oral route
	Frequent emergency room visits or hospitalizations