Jan Tack, Florencia Carbone; Alessandra Rotondo


Curr Opin Gastroenterol. 2015;31(6):499-505. 

In This Article


The gastroparesis concept continues to struggle with a lack of association of symptoms with emptying delay, and a meta-analysis showing no relationship between enhancement of gastric emptying with prokinetics and symptom improvement. Other factors involved in pathophysiology based on recent studies include increased pyloric resistance and altered duodenal contractility. Pathophysiological studies confirm the importance of neuropathy and poor glycemic control as a long-term risk factor in the pathogenesis of gastroparesis in type 1 diabetes. At least in the shorter-term, the role of poor glycemic control in determining abnormal gastric motility in type 2 diabetes is less clear. In type 1 diabetes, loss of ICCs, perhaps mediated through a lack of M2 macrophages, may be a key event at the cellular level. Studies with the ghrelin agonist TRP-102 in diabetic gastroparesis and with tricyclic antidepressants in idiopathic gastroparesis failed to show benefit. The role of dietary therapy is being explored, and case series of favorable outcome with surgical or endoscopic interventions have been published.