Copyright ©The Author(s) 2020.
World J Gastroenterol. May 21, 2020; 26(19): 2333-2348
Published online May 21, 2020. doi: 10.3748/wjg.v26.i19.2333
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
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)
Table 2 Medications and drugs able to delay gastric emptying
Medications and drugs able to delay gastric emptying
Aluminum hydroxide antacids
Beta-adrenergic receptor agonists (beta-agonists)
Calcium channel blockers
Glucagon hydrochloride and glucagon-like peptide-1 analogs
H2-receptor antagonists
Octreotide acetate
Peginterferon alfa (interferon alfa)
Proton pump inhibitors
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 gastroparesisModerate gastroparesisSevere gastroparesis
Diet and nutritional supportAdequate oral nutritionDisturbed oral nutritionCompromized oral nutrition
Small frequent meals; Low fat, low fibre; Glycemic control in diabeticsSmall, frequent meals; Low fat, low fibre; Glycemic control in diabetics; Caloric liquids; Artificial nutrition rarely requiredLiquid nutrient supplements; Nutrition by PEG-J
ProkineticsMetroclopramide; Domperidone; LevosulpirideMetroclopramide; Domperidone; Levosulpiride1Metroclopramide; Domperidone; 1Levosulpiride; 1Erytromycin; Prucalopride
Antiemetics and symptom modulatorsRarely neededOndansetron1Ondansetron; Triciclic antidepressant; Cannabinoids
Drug-refractory patients
Endoscopic techniquesNot neededNot neededBotulin toxin; Transpyloric stenting; Ballon dilatation; G-POEM
Gastric electrostimulationNot neededNot neededCompassionate use
Gastric proceduresNot neededNot neededLaparoscopic Pyloroplastic