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Representation of gastroparesis (Gp) as a pan-enteric disorder that involves impaired fundal accommodation, visceral hypersensitivity, delayed gastric emptying, abnormal small bowel transit, and delayed colonic transit
Source publication
Purpose of review:
This review highlights recent work that will lead to near-term advances in the understanding and treatment of gastroparesis (Gp).
Recent findings:
Major current advancements in the pathophysiology of Gp, include recognition of the SIP syncytium as the pacemaking unit rather than ICC alone and that Gp may be part of a pan-enter...
Citations
... A disorder called gastroparesis is characterized by a delayed stomach emptying. [1][2][3] The global prevalence of gastroparesis-like symptoms (GPLS) was 0.9% overall and 1.3% among individuals with diabetes. 1,2 In the US, the prevalence of gastroparesis is estimated to be approximately 267.7 per 100,000 adults. ...
... 1,2 Gastroparesis is usually diagnosed based on clinical symptoms and delayed gastric emptying demonstrated by imaging tests. [1][2][3] New techniques for assessing gastric emptying, such as the gastric emptying breath test and wireless motility capsules, allow clinicians to better characterize their patients. 2 The goals of symptomatic control, notwithstanding the limitations of existing treatments, are to improve stomach emptying, reduce nausea and vomiting, and manage related abdominal discomfort. ...
... Intense cooperation in this field is only carried out by China and the United States. 7,9,10,12,13,15,19,[25][26][27][28][29][30] Non cutaneus 48 documents [1][2][3][4][5][6]8,11,14,[16][17][18][20][21][22][23][24] Discussion ...
Introduction
Gastroparesis is a condition characterized by the accumulation of bile salts. It is prevalent globally, with a global prevalence of 0.9% and 1.3% in individuals with diabetes. New techniques for diagnosing gastroparesis, such as bile salt titration and nitric oxide sulfate, can improve patient care. However, simptomatic control is needed to increase gastric salts, reduce inflammation, and control potential diseases. Gastroparesis can cause complications like weight loss, malnutrition, and gastrointestinal changes that cannot be predicted. Neurological techniques like gyroscope stimulation and endoscopy (G-POEM) can help diagnose refractive gastroparesis. Interdisciplinary collaboration is crucial in addressing gastroparesis issues, and bibliometric research is essential for finding effective new treatments.
Methods
In this work, a literature review methodology is employed to gather data from the Scopus database using the keywords neuroaid. Data were analyzed using Biblioshiny and VOSviewer software to produce visualizations and bibliometric maps. We conducted quantitative and qualitative analysis.
Results
The research trend found are documents by year, most relevant sources, factorial map of the most cited documents, factorial map of The documents with the highest contributes, documents by author, documents by country or territory, documents by subject area, documents by affiliation, network visualization, overlay visualization of scopus database using vosviewer, density visualization, thematic map, thematic evolution, cluster analysis, topic dendogram, and country collaboration map.
Conclusions
The study on gastroparesis identifies key themes such as diet modification, glucose control, and medication therapy. It also discusses the role of Cajal in smooth muscle concentration, common causes of gastroparesis, and transcutaneous stimulation. The study also explores motorcycle themes, such as the vagus nerve, and emerging themes like devices and electronics. Basic themes include gastrointestinal disorders, neuromodulation, patients, diabetes, and gastric electrical stimulation. Management involves multidisciplinary approaches, lifestyle changes, medication therapy, and bedtime interventions.
... For patients who do not respond to the conventional regimen, treatment strategies include peripyloric botulinum toxin injection, gastric electrical stimulation, surgery, and endoscopic intervention to disrupt the pyloric outlet, thereby improving gastric emptying and alleviating gastroparesis symptoms. Peripyloric botulinum toxin injection is highly anticipated to be useful for the treatment of gastroparesis [39]; however, although some studies seem to demonstrate the effectiveness of this treatment, randomized controlled trials have failed to show any improvement in symptoms [40]. According to a meta-analysis of gastric electrical stimulation for the treatment of gastroparesis, the clinical response rate at 24 months was 53.7%, and 56.5% of gastric electrical stimulation patients experienced clinical relapse within 2 years [41]. ...
... Hence, it is beneficial for centers with endoscopic operating conditions to carry out and promote G-POME such that more gastroparesis patients for whom drug and dietary management have failed can receive safe and effective treatment, reducing the problems caused by gastroparesis. The safety and technical success rate of G-POME in the treatment of gastroparesis have been confirmed [14,39,48], with an overall incidence of adverse events ranging from 0% to 6.7% [4,18,49,50]. Serious adverse events include gastrointestinal bleeding, pyloric ulcers, and capnoperitoneum. ...
Gastric peroral endoscopic myotomy (G-POME) is an emerging minimally invasive endoscopic technique involving the establishment of a submucosal tunnel around the pyloric sphincter. In 2013, Khashab et al used G-POME for the first time in the treatment of gastroparesis with enhanced therapeutic efficacy, providing a new direction for the treatment of gastroparesis. With the recent and rapid development of G-POME therapy technology, progress has been made in the treatment of gastroparesis and other upper digestive tract diseases, such as congenital hypertrophic pyloric stenosis and gastric sleeve stricture, with G-POME. This article reviews the research progress and future prospects of G-POME for the treatment of upper digestive tract gastrointestinal diseases.
... Gastroparesis (GP) is a chronic disorder characterized by gastric dysmotility, resulting in recurrent or persistent upper gastrointestinal (GI) symptoms, such as nausea and vomiting, early satiety, postprandial fullness, bloating, and epigastric/abdominal pain or discomfort, in the absence of a mechanical obstruction [1][2][3]. It significantly impairs quality of life (QoL) in up to 40% of patients, affecting social functioning and mental health [4]. ...
... The imaging process includes acquiring scans with an antero-posterior γ-camera 0, 1, 2, and 4 h after meal ingestion, following the well-established Tougas protocol ( Figure 1) [20,59]. The addition of the 4 h timepoint has significantly improved GES diagnostic accuracy, increasing the yield by 50% compared to relying solely on the 2 h timepoint [2]. Research has also shown a positive correlation between GES with a 3 h timepoint and the severity of symptoms in GP patients [60]. ...
Gastroparesis (GP) is a chronic disease characterized by upper gastrointestinal symptoms, primarily nausea and vomiting, and delayed gastric emptying (GE), in the absence of mechanical GI obstruction. The underlying pathophysiology of GP remains unclear, but factors contributing to the condition include vagal nerve dysfunction, impaired gastric fundic accommodation, antral hypomotility, gastric dysrhythmias, and pyloric dysfunction. Currently, gastric emptying scintigraphy (GES) is considered the gold standard for GP diagnosis. However, the overall delay in GE weakly correlates with GP symptoms and their severity. Recent research efforts have focused on developing treatments that address the presumed underlying pathophysiological mechanisms of GP, such as pyloric hypertonicity, with Gastric Peroral Endoscopic Myotomy (G-POEM) one of these procedures. New promising diagnostic tools for gastroparesis include wireless motility capsule (WMC), the 13 carbon-GE breath test, high-resolution electrogastrography, and the Endoluminal Functional Lumen Imaging Probe (EndoFLIP). Some of these tools assess alterations beyond GE, such as muscular electrical activity and pyloric tone. These modalities have the potential to characterize the pathophysiology of gastroparesis, identifying patients who may benefit from targeted therapies. The aim of this review is to provide an overview of the current knowledge on diagnostic pathways in GP, with a focus on the association between diagnosis, symptoms, and treatment.
... The prevalence of DG varies widely. Several studies intended to determine the association between gender differences and the prevalence of gastroparesis among DM patients [12,13], and have established that comorbid conditions (age, alcohol ingestion, and cigarette smoking) drastically downgrade the quality of life in patients [14,15]. ...
... The prevalence of DG was substantially greater in T2DM patients with >9 % (very high) HbA1c than in patients with 7-9% (high) HbA1c or <7% (controlled) HbA1c ( Figure 2). A similar result suggesting a strong correlation between gastroparesis-related symptoms with higher HbA1C and hyperglycemia was reported by Parkman et al. [14], Sharma et al. [15], and Kim et al. [16]. This showed that good glycemic control in T2DM patients helps recover gastroparesis-related symptoms and complications [17][18][19][20]. ...
Background
The symptoms of gastroparesis, such as bloating, postprandial fullness, early satiety, nausea, and abdominal discomfort, progressively worsen the quality of life of the affected individuals. The diagnosis is established on the assessment of gastric function that confirms delayed gastric emptying in the absence of structural etiologies. This study aimed to detect gastroparesis-related clinical symptoms early in patients with type 2 diabetes mellitus (T2DM), investigate the concomitant risk factors, and evaluate the prevalence.
Methodology
This study was conducted at the Department of Medicine and Diabetes Outdoor Clinic of Sheikh Zayed Hospital, Rahim Yar Khan from February 13, 2022, to February 11, 2023. The study involved 175 patients with T2DM who reported gastroparesis-related symptoms. The demographic and clinical characteristics, symptom severity, complications, related risk factors, duration of disease, medications, body mass index (BMI), fasting plasma glucose, and glycated hemoglobin (HbA1C) levels were assessed. The severity of diabetic gastroparesis was established using the disease-specific Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) and the Gastroparesis Cardinal Symptom Index (GCSI). The five-point scale of the PAGI-SYM and the four-degree severity scores of GCSI were assessed. Neuropathy disability scores and motor evacuation functions were analyzed. Data were analyzed from these questionnaires, special proforma, and patient interviews.
Results
The clinical features of diabetic gastroparesis were observed in 44% of T2DM patients with mild-grade gastroparesis in 38 (21.7%), moderate in 30 (17.1%), and severe-grade gastroparesis-related symptoms in nine (5.2%) patients. The main manifestations were early satiety (45.1%), stomach fullness (44.5%), bloating (38.3%), and nausea (33.1%). Diabetic gastroparesis symptoms were considerably linked to disease duration of more than 10 years (p = 0.02), high HbA1c (p = 0.001), increased fasting blood glucose (p = 0.003), polyneuropathy, cigarette smoking, and history of comorbid conditions (p = 0.009). Obesity and the female gender were the forecasters of the manifestation of at least one cardinal gastroparesis symptom.
Conclusions
Gastric emptying is significant in the pathogenesis of gastroparesis-related symptoms. Disease duration of more than 10 years, poor glycemic control with hyperglycemia, high HbA1C, polyneuropathy, and cigarette smoking must be considered as predictors for early detection and risk factors for the advancement of gastroparesis in T2DM. Gastroparesis-related common symptoms of early satiety, bloating, and stomach fullness were considerably linked to the additional risk factors of hypercholesteremia, chronic microvascular complications, concomitant cardiovascular diseases, and a positive family history of diabetes mellitus. There was no relationship between BMI, age, types of treatment, and the degree of gastroparesis severity. The prevalence and severity of gastroparesis symptoms were particularly high among obese females with poor glycemic control and longer disease duration.
... Several mechanisms can be distinguished; for example, impaired fundus relaxation due to increased fundic tone, decreased antral contractility and decreased pyloric relaxation. 1 Different causes for these abnormalities have been identified. For example, the interstitial cells of Cajal (ICC), which act as a pacemaker of gastric motility, are often reduced in number and functionality. ...
Background
Gastroparesis (GP) occurs in patients after upper gastrointestinal surgery, in patients with diabetes or systemic sclerosis and in idiopathic GP patients. As pyloric dysfunction is considered one of the underlying mechanisms, measuring this mechanism with EndoFLIP™ can lead to a better understanding of the disease.
Methods
Between November 2021 and March 2022, we performed a retrospective single-centre study of all patients who had non-surgical GP, post-surgical GP and no sign of GP after esophagectomy and who underwent our post-surgery follow-up program with surveillance endoscopies and further exams. EndoFLIP™ was used to perform measurements of the pylorus, and distensibility was measured at 40 ml, 45 ml and 50 ml balloon filling.
Results
We included 66 patients, and successful application of the EndoFLIP™ was achieved in all interventions ( n = 66, 100%). We identified 18 patients suffering from non-surgical GP, 23 patients suffering from GP after surgery and 25 patients without GP after esophagectomy. At 40, 45 and 50 ml balloon filling, the mean distensibility in gastroparetic patients was 8.2, 6.2 and 4.5 mm ² /mmHg; 5.4, 5.1 and 4.7 mm ² /mmHg in post-surgical patients suffering of GP; and 8.5, 7.6 and 6.3 mm ² /mmHg in asymptomatic post-surgical patients. Differences between symptomatic and asymptomatic patients were significant.
Conclusion
Measurement with EndoFLIP™ showed that asymptomatic post-surgery patients seem to have a higher pyloric distensibility. Pyloric distensibility and symptoms of GP seem to correspond.
... 37 The numerical values of reported lag times for 13 Several lines of evidence, listed in Table 3, have suggested that autoantibodies may drive inflammation and contribute to diverse gastrointestinal dysmotility disorders, including gastroparesis. [43][44][45][46][47][48][49] These ...
Background
Gastroparesis is a complex, challenging gastrointestinal disorder presenting with upper gastrointestinal symptoms, especially nausea and vomiting, with significant impact on patients' quality of life. After ruling out mechanical obstruction, it is essential to identify delay in gastric emptying for definitive diagnosis. The most common causes are idiopathic (no identified etiology), diabetes mellitus, and postsurgical status. Management of gastroparesis focuses on dietary modifications and treatment directed to symptom relief. Unfortunately, approximately one‐third of patients are refractory to pharmacological therapy, and the effectiveness of the few nonpharmacological options has been questioned.
Purpose
Extensive review of the literature identifies several uncertainties or controversies regarding the differential diagnosis based on the spectrum of symptoms, the lack of availability of reliable diagnostic test, and questions regarding effective therapeutic options. In this review, we discuss ten controversies regarding gastroparesis: clinical presentation, diagnosis, overlap syndromes, pathophysiology, etiology, as well as pharmacological and nonpharmacological therapeutic options. In addition, we briefly review studies exploring pathological, inflammatory, and molecular disturbances affecting the intrinsic neuromuscular elements that may be involved in the pathophysiology of gastroparesis and may constitute possible therapeutic targets in the future. Finally, we tabulate future research opportunities to resolve these controversies in the management of patients with gastroparesis.
... Por lo anterior, la capacitancia de la unión esofagogástrica determinada por FLIP es una medida que requiere mayor investigación para mejorar los resultados de la funduplicatura laparoscópica y evitar malos desenlaces 8 . en el futuro puede ser de utilidad para caracterizar otras alteraciones intestinales, lo cual también requiere mayores investigaciones 12,13 . ...
... 22,96,97 Available endoscopic modalities include intramuscular pyloric botulinum injection, transpyloric stenting, pyloric dilation, and gastric peroral endoscopic pyloromyotomy (G-POEM). 76 Pylorospasm is defined as a high-amplitude long contraction of pyloric muscle and is associated with muscular fibrosis and loss of interstitial cell of Cajal. 98 Recent studies on surgical pyloroplasty and transpyloric stenting demonstrated an improvement of both GCSI and gastric emptying, 99-103 however, randomized controlled trials of intrapyloric botulinum injection failed to show symptomatic improvement compared to sham saline injection despite improvement in gastric emptying. ...
... 115 Despite its technical challenges that demands expertise in third space endoscopy, technical success of G-POEM has been reported at almost 100%. 22,76,108,109,111 It is important to recognize that these results were likely subject to publication bias and all procedures were performed by expert endoscopists who are highly experienced in submucosal endoscopy. The learning curve of the procedure, even in the experts' hands, was estimated to be at 18 procedures. ...
Gastroparesis, once regarded as a rare disease, is difficult to diagnose and challenging to treat; there were many breakthrough advances in the 2010s, shifting the paradigm of the understanding of this complex entity and its management. Similar to diabetes, its increasing prevalence reflects increased accessibility to diagnostic modalities and suggests that gastroparesis was underacknowledged in the past. Major developments in the three main aspects of the disease include the discovery of smooth muscle cells, interstitial cells of Cajal, PDGFRα+ cells syncytium, rather than interstitial cells of Cajal alone, as the main gastric pacemaker unit; the development of validated point-of-care diagnostic modalities such as a wireless motility capsule, the carbon 13-labeled breath test, and impedance planimetry; and the introduction of novel minimally invasive therapeutic options such as newer pharmacologic agents and gastric peroral endoscopic pyloromyotomy. All aspects of these advances will be discussed further in this review.
... It has been postulated that ICC, PDGFRα+ cells, and smooth muscle cells form a syncytium. This controls intracellular voltage-gated calcium (Ca 2+ ) in a cyclical manner leading to high-amplitude contractions [24]. A positive correlation exists between velocity and extracellular amplitude which is physiologically necessary for the normal gastric motility regulation [25]. ...
Abstract
Gastroparesis is a neuromuscular disorder whose hallmark is delayed gastric emptying. It is a global
challenge to the healthcare system because of poor treatment satisfaction for both the patients and
clinicians, eventually leading to a reduction in the quality of life, with antecedent anxiety and depression.
Although it is multifactorial in origin, diabetic, idiopathic, and drug-induced gastroparesis are the major risk
factors. Disrupted interstitial cells of Cajal (ICC) and gastric dysrhythmia are pivotal to the pathogenesis,
with most of the investigations targeted toward assessing gastric emptying and accommodation usually
affected by distorted ICC and other neural networks. The treatment challenges can be overcome by a
multidisciplinary approach involving gastroenterologists, gastrointestinal surgeons, biomedical engineers,
nutritionists, psychologists, nurses, radionuclide radiologists, pharmacists, and family physicians. The
exploration of the fundamental physiological processes underlying gastroparesis with the use of
biomechanical materials should be given more attention by biomedical engineers to integrate innovative
engineering with medicine for solving complex medical issues.
... It has been postulated that ICC, PDGFRα+ cells, and smooth muscle cells form a syncytium. This controls intracellular voltage-gated calcium (Ca 2+ ) in a cyclical manner leading to high-amplitude contractions [24]. A positive correlation exists between velocity and extracellular amplitude which is physiologically necessary for the normal gastric motility regulation [25]. ...
Gastroparesis is a neuromuscular disorder whose hallmark is delayed gastric emptying. It is a global challenge to the healthcare system because of poor treatment satisfaction for both the patients and clinicians, eventually leading to a reduction in the quality of life, with antecedent anxiety and depression. Although it is multifactorial in origin, diabetic, idiopathic, and drug-induced gastroparesis are the major risk factors. Disrupted interstitial cells of Cajal (ICC) and gastric dysrhythmia are pivotal to the pathogenesis, with most of the investigations targeted toward assessing gastric emptying and accommodation usually affected by distorted ICC and other neural networks. The treatment challenges can be overcome by a multidisciplinary approach involving gastroenterologists, gastrointestinal surgeons, biomedical engineers, nutritionists, psychologists, nurses, radionuclide radiologists, pharmacists, and family physicians. The exploration of the fundamental physiological processes underlying gastroparesis with the use of biomechanical materials should be given more attention by biomedical engineers to integrate innovative engineering with medicine for solving complex medical issues.
