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Treatment options for patients with severe gastroparesis
  1. Hasse Abrahamsson
  1. Correspondence to:
    Professor H Abrahamsson
    Department of Internal Medicine, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden; hasse.abrahamsson{at}medic.gu.se

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Chronic gastroparesis is a motility dysfunction often associated with severe symptoms, the most common disabling symptoms being nausea and vomiting. The term “gastroparesis” is a Greek word that means “a weakness of movement”. In this article, some basic facts about gastroparesis are briefly mentioned before aspects on therapy are discussed.

Gastroparesis is defined as delayed gastric emptying in the absence of an obstruction to outflow from the stomach. Hence, the diagnostic procedure in patients with symptoms suggestive of gastroparesis should include at least gastroscopy, so as to exclude obstructive lesions. Furthermore, a gastric emptying test is required to verify abnormal emptying of the stomach. Although delayed emptying of both liquids and solids occurs in patients with gastroparesis, the delayed emptying of solids is considered the most relevant disturbance. Thus, a test of solid emptying is usually applied. The scintigraphic method is considered to be the gold standard. Reference values based on large control samples (>100 subjects) are available for the scintigraphic method1,2 and for the radiological method.3 In addition, the octanoic acid breath test with reference values from 70 subjects4 is also frequently used. The larger control samples show a gender difference with a slower emptying rate and higher reference values for retention in healthy women compared with men.2,3 Gastric emptying cannot be reliably evaluated by gastroscopy.

PATIENT GROUPS

In gastrointestinal (GI) practice, gastroparesis is common among patients with diabetes mellitus, and is reported to occur in 30–50% of the patients.5 Another large group comprises patients with idiopathic gastroparesis in whom no underlying cause of the disorder can be found. However, many patients with idiopathic gastroparesis have developed the disorder after a gastrointestinal infection, most often a virus infection.6,7 Bacterial infections may also cause gastroparesis, but Helicobacter pylori does not seem to be …

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