Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. May 21, 2020; 26(19): 2333-2348
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2333
Gastroparesis: New insights into an old disease
Paolo Usai-Satta, Massimo Bellini, Olivia Morelli, Francesca Geri, Mariantonia Lai, Gabrio Bassotti
Paolo Usai-Satta, Department of Internal Medicine, Division of Gastroenterology, Brotzu Hospital, Cagliari 09124, Italy
Massimo Bellini, Francesca Geri, Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56122, Italy
Olivia Morelli, Gabrio Bassotti, Gastroenterology and Hepatology Section, Department of Medicine, University of Perugia Medical School, Perugia 06123, Italy
Mariantonia Lai, Gastroenterology Unit, University of Cagliari, Monserrato 09042, Italy
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Paolo Usai-Satta, MD, Attending Doctor, Department of Internal Medicine, Division of Gastroenterology, Brotzu Hospital, Piazza Ricchi 1, Cagliari 09124, Italy.
Received: January 23, 2020
Peer-review started: January 23, 2020
First decision: March 6, 2020
Revised: March 8, 2020
Accepted: May 1, 2020
Article in press: May 1, 2020
Published online: May 21, 2020

Gastroparesis (Gp) is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction. Although this condition has been reported in the literature since the mid-1900s, only recently has there been renewed clinical and scientific interest in this disease, which has a potentially great impact on the quality of life. The aim of this review is to explore the pathophysiological, diagnostic and therapeutical aspects of Gp according to the most recent evidence. A comprehensive online search for Gp was carried out using MEDLINE and EMBASE. Gp is the result of neuromuscular abnormalities of the gastric motor function. There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes. As regards diagnostic approach, 99-Technetium scintigraphy is currently considered to be the gold standard for Gp. Its limits are a lack of standardization and a mild risk of radiation exposure. The C13 breath testing is a valid and safe alternative method. 13C acid octanoic and the 13C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits. The wireless motility capsule is a promising technique, but its use is limited by costs and scarce availability in many countries. Finally, therapeutic strategies are related to the clinical severity of Gp. In mild and moderate Gp, dietary modification and prokinetic agents are generally sufficient. Metoclopramide is the only drug approved by the Food and Drug Administration for Gp. However, other older and new prokinetics and antiemetics can be considered. As a second-line therapy, tricyclic antidepressants and cannabinoids have been proposed. In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed. In drug-unresponsive Gp patients some alternative strategies (endoscopic, electric stimulation or surgery) are available.

Keywords: Gastroparesis, Delayed gastric emptying, Gastric Scintigraphy, 13C breath testing, Wireless motility capsule, Prokinetics, Antiemetic drugs, Gastric-per-oral endoscopic myotomy, Gastric electrical stimulation

Core tip: Gastroparesis has a great impact on the quality of life and a heavy economic burden. Our objective was to consolidate current knowledge on its pathophysiology, diagnosis and therapy. Recent evidence has shown that gastroparesis may be due to intrinsic neuropathy. Diagnostic tests that are validated and available are 99-Technetium scintigraphy, the 13C breath test and the wireless motility capsule. The therapy is varied and related to the severity of the disease. After dietary modification, old and new prokinetics and antiemetics are available. In drug-refractory patients, endoscopic or surgical procedure may be indicated.