Gastroparesis

Gastroparesis is a chronic motility disorder characterized by delayed gastric emptying in the absence of a mechanical obstruction. The main symptoms are nausea, vomiting, early satiety, bloating, abdominal pain, and weight loss. Symptoms often follow meals and can vary in intensity.

Pathophysiology: Delayed emptying results from impaired gastric motility due to vagal neuropathy, smooth muscle dysfunction, or loss of interstitial cells of Cajal. Diabetes mellitus is the most common known cause; many cases are idiopathic. Other contributing factors include postsurgical vagal injury, infections, autoimmune disease, thyroid dysfunction, and certain medications.

Diagnosis: Evaluation typically rules out obstruction, usually with upper endoscopy. The standard test is gastric emptying scintigraphy, which measures solid meal emptying over several hours. Other options include wireless motility capsule and specialized imaging; gastric manometry may be used in selected cases.

Management: Treatment is individualized and multimodal. Dietary modification is foundational: small, frequent, low-fat, low-fiber meals; liquids or pureed foods can be helpful. Pharmacologic therapy includes prokinetic agents (metoclopramide commonly used; domperidone where available; erythromycin for short-term use) and antiemetics. Glycemic control is important in diabetics. For refractory cases, options include gastric electrical stimulation or pyloric-directed therapies such as G-POEM; botulinum toxin injections into the pylorus have limited evidence. Nutritional support or enteral feeding may be necessary in severe or malnourished patients.

Prognosis and epidemiology: Gastroparesis is usually a long-term condition with fluctuating symptoms. It is more common in women and can affect adults across a wide age range. Management aims at symptom relief and nutrition, with variable treatment responses.