Gastroparesis Phenotyping: Current Methods and Emerging Opportunities With Magnetic Resonance Imaging

Gastroparesis is a complex gastrointestinal motility disorder characterized by delayed gastric emptying. Its pathophysiology varies across patients, arising from impaired fundic tone, antral hypomotility, pylorospasm, antropyloroduodenal incoordination, or combinations thereof. Current clinical diagnostic tools provide only a fragmented assessment of gastric function and lack the comprehensive spatiotemporal details necessary to differentiate these pathophysiological phenotypes, limiting the ability to deliver personalized treatments.

To overcome this gap, we advocate for dynamic magnetic resonance imaging (MRI) as a non-invasive "all-in-one" diagnostic platform for simultaneous evaluation of gastric accommodation, regional wall kinematics, pyloric function, and overall emptying within a single exam following the oral ingestion of a natural-ingredient test meal. This integrated assessment offers a unique capability for gastroparesis phenotyping by characterizing how various types of regional motor dysfunction lead collectively to delayed gastric emptying in each patient. Quantifying MRI-derived phenotypes using a standardized surface scaffold of the gastric musculature creates a functional mapping framework to contrast patient-specific deviations against normative baselines established from healthy cohorts. The framework enables the integration of localized motor phenotypes with underlying structural knowledge for objective explanation of clinical symptoms and evidence-based, personalized treatments. Ultimately, establishing dynamic MRI as the emerging diagnostic standard promises to transform gastroparesis management from an empirical practice into a new era of precision gastroenterology.

Gastroparesis is a disease condition characterized by delayed gastric emptying, which may arise from different underlying causes that existing tests cannot fully distinguish. We review recent advances in dynamic MRI of the upper gastrointestinal tract and demonstrate that dynamic MRI can simultaneously assess gastric emptying, fundic tone, antral and duodenal contractions, and pyloric opening, all in a single examination. We highlight its potential to identify patient-specific patterns of dysfunction and support more precise diagnosis and treatment.