Pathogenesis, investigation and dietary and medical management of gastroparesis

Delayed gastric emptying (gastroparesis) is associated with significant morbidity and, occasionally, mortality; clinicians therefore need a high index of suspicion to avoid missing the diagnosis. This review discusses the aetiology, diagnostic criteria and investigations pertinent to gastroparesis, and also critically reviews the evidence for nutritional and medical management strategies. Dietary manipulation plays a key role in management, and simple adjustment to meal routines and diets can lead to an improvement in symptoms, whereas alternative feeding routes play an important role in more severe cases. The role of pharmaceutical intervention is less clear; prokinetics and antiemetics are often prescribed; however, evidence for their efficacy is lacking, whereas gastric electric stimulation has an evolving role in the management of patients with symptoms refractory to medical therapies. The optimal treatment of gastroparesis would be to resolve symptoms and normalise gastric emptying times, and this may be achieved with future treatments that target the underlying pathology. For most patients with mild to moderate disease, dietary intervention plays a central role in the management of gastroparesis.