Gastroparesis: New insights into an old disease

Table 1 Conditions able to provoke gastroparesis

Conditions able to provoke gastroparesis
Diabetes mellitus
Post-surgical conditions (vagotomy or vagus nerve damage after fundoplication, esophagectomy, gastrectomy, pancreatectomy, Roux-en-Y gastric bypass, heart or lung transplant)
Connective tissue disease (including scleroderma, amyloidosis, Sjogren’s syndrome, LES, polymyositis/dermatomyositis)
Eosinophilic gastroenteritis; infiltrative enteritis
Eating disorders (anorexia nervosa or bulimia)
End-stage renal disease
Hypothyroidism
Infectious diseases (recent viral infection by CMV, EBV, VZV; Chagas disease)
Malignancy (pancreas, lymphoma, paraneoplastic syndrome)
Mesenteric ischemia
Myopathies and muscular dystrophies (myotonic dystrophy, Duchenne muscular dystrophy)
Nervous system disorders (myasthenia gravis, Parkinson’s disease, Guillain Barre syndrome, multiple sclerosis, dysautonomia)
Stroke

LES: Low esophageal sphincter; CMV: Cytomegalovirus; EBV: Epstein-Barr virus; VZV: Varicella zoster virus.

Table 2 Medications and drugs able to delay gastric emptying

Medications and drugs able to delay gastric emptying
Alcohol
Aluminum hydroxide antacids
Anticholinergics
Antipsychotics
Beta-adrenergic receptor agonists (beta-agonists)
Calcitonin
Calcium channel blockers
Cyclosporine
Dexfenfluramine
Diphenhydramine
Glucagon hydrochloride and glucagon-like peptide-1 analogs
H2-receptor antagonists
Octreotide acetate
Opioids
Peginterferon alfa (interferon alfa)
Progesterone
Proton pump inhibitors
Sucralfate
Tobacco
Tricyclic antidepressants

Table 3 Diseases and conditions to be considered in the differential diagnosis

Diseases and conditions to be considered in the differential diagnosis
Angiotensin-converting enzyme inhibitor-related visceral angioedema
Antipsychotic-induced dysmotility
Cannabinoid hyperemesis syndrome
Chronic pancreatitis
Cyclic vomiting syndrome
Dumping syndrome
Eating disorders, such as anorexia nervosa and bulimia nervosa
Functional dyspepsia
Gastric tumors or other malignancies
Gastric outlet or small-bowel obstruction
Gastroesophageal reflux disease
Helicobacter pylori infection
Median arcuate ligament syndrome
Peptic ulcer disease
Rumination syndrome
Small intestinal bacterial overgrowth syndrome
Superior mesenteric artery syndrome

Table 4 Therapeutic strategies

	Mild gastroparesis	Moderate gastroparesis	Severe gastroparesis
Diet and nutritional support	Adequate oral nutrition	Disturbed oral nutrition	Compromized oral nutrition
	Small frequent meals; Low fat, low fibre; Glycemic control in diabetics	Small, frequent meals; Low fat, low fibre; Glycemic control in diabetics; Caloric liquids; Artificial nutrition rarely required	Liquid nutrient supplements; Nutrition by PEG-J
Prokinetics	Metroclopramide; Domperidone; Levosulpiride	Metroclopramide; Domperidone; Levosulpiride	1Metroclopramide; Domperidone; 1Levosulpiride; 1Erytromycin; Prucalopride
Antiemetics and symptom modulators	Rarely needed	Ondansetron	1Ondansetron; Triciclic antidepressant; Cannabinoids
			Drug-refractory patients
Endoscopic techniques	Not needed	Not needed	Botulin toxin; Transpyloric stenting; Ballon dilatation; G-POEM
Gastric electrostimulation	Not needed	Not needed	Compassionate use
Gastric procedures	Not needed	Not needed	Laparoscopic Pyloroplastic

¹Available for intravenous administration. PEG-J: Percutaneous endoscopic transgastric jejunostomy; G-POEM: Gastric peroral endoscopic myotomy.