United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis

Abstract

Background: Gastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction.The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis.Methods: A Delphi consensus was undertaken by 40 experts from 19 European countries who conducted a literature summary and voting process on 89 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation criteria. Consensus (defined as ≥80% agreement) was reached for 25 statements. Results:The European consensus defined gastroparesis as the presence of symptoms associated with delayed GE in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms, with often coexisting postprandial distress syndrome symptoms of dyspepsia. The true epidemiology of gastroparesis is not known in detail, but diabetes, gastric surgery, certain neurological and connective tissue diseases, and the use of certain drugs recognized as risk factors. While the panel agreed that severely impaired gastric motor function is present in these patients, there was no consensus on underlying pathophysiology.The panel agreed that an upper endoscopy and a GE test are required for diagnosis.Only dietary therapy, dopamine-2 antagonists and 5-HT 4 receptor agonists were considered appropriate therapies, in addition to nutritional support in case of severe weight loss. No consensus was reached on the use of proton pump inhibitors, other classes of antiemetics or prokinetics, neuromodulators, complimentary, psychological, or more invasive therapies. Finally, there was consensus that gastroparesis adversely impacts on quality of life and healthcare costs and that the long-term prognosis of gastroparesis depends on the cause.This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Endoscopic pyloromyotomy for the treatment of severe and refractory gastroparesis: a pilot, randomised, sham-controlled trial

“…Gastroparesis (GP) is a gastric motility disorder defined by the presence of upper abdominal symptoms and delayed gastric emptying in the absence of organic obstruction 1 2. Two important aetiologies are diabetes mellitus and GP following oesophageal or gastric surgery (postsurgical GP).…”

Disturbed gastric motility in patients with long-standing diabetes mellitus

“…Some patients with delayed gastric emptying are considered to have GP. GP is a syndrome characterized by delayed gastric emptying in the absence of mechanical obstruction of the stomach (33)(34)(35)(36). The main etiology of GP is DM, accounting for almost one-third of GP cases, and another one-third is idiopathic (37,38).…”

Advances on Neurogastroenterology and Motility Disorders: Pathophysiology, Diagnostics and Management

“…As for gastric symptoms, currently, scintigraphy of a solid meal (using a 99m Technetium-labeled egg) is considered the gold standard for gastroparesis diagnosis [ 21 ]. However, breath tests and wireless motility capsules may be alternatives to scintigraphy for the assessment of gastric emptying [ 21 ].…”

“…As for gastric symptoms, currently, scintigraphy of a solid meal (using a 99m Technetium-labeled egg) is considered the gold standard for gastroparesis diagnosis [ 21 ]. However, breath tests and wireless motility capsules may be alternatives to scintigraphy for the assessment of gastric emptying [ 21 ]. In addition, in this context, EndoFLIP showed some important advancements for the clinically relevant disorders of the pylorus, requiring more invasive therapy when symptoms of gastroparesis are severe [ 12 ].…”