ABSTRACT

Gastroparesis (GP) is a chronic debilitating dysmotility disorder that is defined as delayed gastric emptying in the absence of mechanical obstruction. It is characterized by unrelenting nausea, vomiting, bloating, early satiety, postprandial fullness and abdominal pain. Several etiologies can lead to this clinical entity, the most common of these are idiopathic, diabetic and postsurgical. Patients with GP may experience associated conditions including gastroesophageal reflux disease, gastric bezoars and small bowel bacterial overgrowth. The use of gastric emptying scintigraphy is the gold standard in diagnosing GP. Other modalities used to diagnose GP include either the gastric emptying breath test (GEBT) or the use of a wireless motility capsule.

The management of GP includes restoration of nutritional state, optimization of glycemic control, symptom relief and improvement in gastric emptying. The evaluation of nutritional status and early treatment of malnutrition are imperative in the management of refractory GP. Malnutrition is very common in these patients. Therefore, a thorough understanding of the disease process of GP is essential in order to prevent malnutrition and improve overall quality of life. Currently, the medical therapies used for the management of GP consist of prokinetics, antiemetics and glycemic control. Unfortunately, in many cases these drug therapies are often not as effective. Endoscopic and surgical methods are available and reserved for refractory cases. Current options beyond drug therapy include intrapyloric botulinum injection, gastric-electrical stimulation, venting gastrostomy, feeding jejunostomy, surgical pyloroplasty or partial gastrectomy and endoscopic gastric per-oral endoscopic myotomy (G-POEM) called also per-oral endoscopic pyloromyotomy (POP).

This chapter explores a systematic approach including nutritional screening, diet recommendations, medical therapy, surgical therapy and the use of enteral or parenteral nutrition to improve overall quality of life in patients with GP while additionally protecting a patient's autonomy.