Symptoms and diagnosis of gastroparesis

Gastroparesis is characterised by delayed gastric emptying. It is associated with a variety of symptoms including bloating, epigastric fullness, early satiety, abdominal pain and nausea and vomiting; however, not all symptoms can be attributed directly to the delay in gastric emptyingStrijbos, 2019. Symptom severity only weakly correlates with the degree of delay in gastric emptyingSmith, 2019.

Gastroparesis is commonly idiopathic; however, underlying causes include:

• diabetes (usually with other evidence of autonomic neuropathy)Strijbos, 2019
• systemic diseases such as autoimmune diseases and neuromuscular degenerative conditions
• upper gastrointestinal surgery (eg vagotomy, gastric surgery, oesophageal surgery)Strijbos, 2019
• reversible conditions such as severe weight loss due to an eating disorder, or drugs that delay gastric emptying (eg opioids, glucagon-like peptide-1 [GLP-1] analogues)Sullivan, 2020.

An upper gastrointestinal endoscopy is recommended to exclude a mechanical cause of obstruction. Endoscopy may demonstrate retained food in patients with gastroparesisSmith, 2019.

If endoscopy does not demonstrate an obstructive cause, a nuclear medicine gastric emptying study should be performed to confirm the diagnosis.

Gastroparesis (particularly idiopathic gastroparesis) may be associated with hypermobility syndrome, autonomic dysfunction and significant psychiatric comorbidity. Exclude other causes with appropriate investigation.