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  • 1. Aims and Scope

    Gut and Liver is an international journal of gastroenterology, focusing on the gastrointestinal tract, liver, biliary tree, pancreas, motility, and neurogastroenterology. Gut atnd Liver delivers up-to-date, authoritative papers on both clinical and research-based topics in gastroenterology. The Journal publishes original articles, case reports, brief communications, letters to the editor and invited review articles in the field of gastroenterology. The Journal is operated by internationally renowned editorial boards and designed to provide a global opportunity to promote academic developments in the field of gastroenterology and hepatology. +MORE

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    Yong Chan Lee Professor of Medicine
    Director, Gastrointestinal Research Laboratory
    Veterans Affairs Medical Center, Univ. California San Francisco
    San Francisco, USA

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    Deputy Editor
    Jong Pil Im Seoul National University College of Medicine, Seoul, Korea
    Robert S. Bresalier University of Texas M. D. Anderson Cancer Center, Houston, USA
    Steven H. Itzkowitz Mount Sinai Medical Center, NY, USA
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    All papers submitted to Gut and Liver are reviewed by the editorial team before being sent out for an external peer review to rule out papers that have low priority, insufficient originality, scientific flaws, or the absence of a message of importance to the readers of the Journal. A decision about these papers will usually be made within two or three weeks.
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Gastroparesis Updates on Pathogenesis and Management

Nanlong Liu, and Thomas Abell

Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, USA

Correspondence to: Thomas Abell, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, 550 South Jackson Street, ACB3 A3L15, Louisville, KY 40202, USA, Tel: +1-502-852-6991, Fax: +1-502-852-0846, E-mail: thomas.abell@louisville.edu

Received: July 6, 2016; Accepted: September 9, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Gut and Liver 2017; 11(5): 579-589

Published online September 15, 2017 https://doi.org/10.5009/gnl16336

Copyright © Gut and Liver.

Abstract

Gastroparesis (Gp) is a chronic disease that presents with clinical symptoms of early satiety, bloating, nausea, vomiting, and abdominal pain. Along with these symptoms, an objective finding of delayed gastric emptying, along with a documented absence of gastric outlet obstruction, are required for diagnosis. This article focuses on updates in the pathogenesis and management of Gp. Recent studies on full thickness biopsies of Gp patients have shed light on the complex interactions of the central, autonomic, and enteric nervous systems, which all play key roles in maintaining normal gut motility. The management of Gp has evolved beyond prokinetics and antiemetics with the use of gastric electrical stimulators (GES). In addition, this review aims to introduce the concept of gastroparesis-like syndrome (GLS). GLS helps groups of patients who have the cardinal symptoms of Gp but have a normal or rapid emptying test. Recent tests have shown that patients with Gp and GLS have similar pathophysiology, benefit greatly from GES placement, and likely should be treated in a similar manner.

Keywords: Nausea, Vomiting, Gastroparesis, Enteric nervous system, Gastric emptying


Article

Review

Gut and Liver 2017; 11(5): 579-589

Published online September 15, 2017 https://doi.org/10.5009/gnl16336

Copyright © Gut and Liver.

Gastroparesis Updates on Pathogenesis and Management

Nanlong Liu, and Thomas Abell

Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, Louisville, KY, USA

Correspondence to: Thomas Abell, Division of Gastroenterology, Hepatology, and Nutrition, University of Louisville, 550 South Jackson Street, ACB3 A3L15, Louisville, KY 40202, USA, Tel: +1-502-852-6991, Fax: +1-502-852-0846, E-mail: thomas.abell@louisville.edu

Received: July 6, 2016; Accepted: September 9, 2016

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Gastroparesis (Gp) is a chronic disease that presents with clinical symptoms of early satiety, bloating, nausea, vomiting, and abdominal pain. Along with these symptoms, an objective finding of delayed gastric emptying, along with a documented absence of gastric outlet obstruction, are required for diagnosis. This article focuses on updates in the pathogenesis and management of Gp. Recent studies on full thickness biopsies of Gp patients have shed light on the complex interactions of the central, autonomic, and enteric nervous systems, which all play key roles in maintaining normal gut motility. The management of Gp has evolved beyond prokinetics and antiemetics with the use of gastric electrical stimulators (GES). In addition, this review aims to introduce the concept of gastroparesis-like syndrome (GLS). GLS helps groups of patients who have the cardinal symptoms of Gp but have a normal or rapid emptying test. Recent tests have shown that patients with Gp and GLS have similar pathophysiology, benefit greatly from GES placement, and likely should be treated in a similar manner.

Keywords: Nausea, Vomiting, Gastroparesis, Enteric nervous system, Gastric emptying

Fig 1.

Figure 1.Electron microscopy of the interstitial cells of Cajal (ICC) network in gastric smooth muscle in a chronic unexplained nausea and vomiting (CUNV) patient. (A) Compared with the control (B). Labeled structural components: thick basal lamina (small asterisks), nerve endings (NEs), smooth muscle cells (SMCs), lamellar body (LB), contact between ICC and SMCs (arrows), peg-and-socket junction (large asterisks). Adapted from Angeli TR, et al. Gastroenterology 2015;149:56–66.e5, with permission from Elsevier.
Gut and Liver 2017; 11: 579-589https://doi.org/10.5009/gnl16336

Fig 2.

Figure 2.Interaction of interstitial cells of Cajal (ICC) cells and neuronal nitric oxide synthase (nNOS) signaling for normal gastric emptying (GE).

NO, nitric oxide; Ach, acetylcholine; SMC, smooth muscle cell.

Gut and Liver 2017; 11: 579-589https://doi.org/10.5009/gnl16336

Fig 3.

Figure 3.Conceptual framework for pathophysiology of gastroparesis syndromes.

CNS, central nervous system; ANS, autonomic nervous system; ENS, enteric nervous system; PNS, parasympathetic nervous system; SNS, sympathetic nervous system.

Gut and Liver 2017; 11: 579-589https://doi.org/10.5009/gnl16336

Fig 4.

Figure 4.Diagnosis and management algorithm for gastroparesis (Gp) syndromes.

EGD, esophagogastroduodenoscopy; GES, gastric electrical stimulators.

Gut and Liver 2017; 11: 579-589https://doi.org/10.5009/gnl16336

Table 1 Etiologies of Gastroparesis

Major etiologies of Gp
 Idiopathic gastroparesis
 Diabetic gastroparesis
 Postsurgical gastroparesis 
Minor etiologies of Gp
 Parkinsonism
 Amyloidosis
 Paraneoplastic
 Scleroderma
 Mesenteric ischemia

Gp, gastroparesis.


Table 2 Comparison of Gastroparesis-Like Syndrome and Gastroparesis

GCSI scoresGE studyICCGES response
GLS No differenceNormal, rapid Decreased Therapeutic
GpNo differenceDelayedDecreased further Therapeutic

GCSI, Gastric Cardinal Scoring Index; GE, gastric emptying; ICC, interstitial cells of Cajal; GES, gastric electrical stimulator; GLS, gastroparesis-like syndrome; Gp, gastroparesis.


Table 3 Gastroparesis Symptom Cardinal Index

NoneVery mildMildModerateSevereVery severe
1. Nausea012345
2. Retching012345
3. Vomiting012345
4. Stomach fullness012345
5. Not able to finish a normal-sized meal012345
6. Feeling excessively full after meals012345
7. Loss of appetite012345
8. Bloating012345
9. Stomach or belly visibly larger012345

For each symptom, please circle the number that best describes how severe the symptom has been during the past 2 weeks. If you have not experienced this symptom, circle 0.

Adapted from Revicki DA, et al. Aliment Pharmacol Ther 2003;18:141–150, with permission from John Wiley & Sons.15


Table 4 Patient-Reported Gastrointestinal Outcomes and Total Symptom Score

Symptom Frequency SeverityAverage
Vomiting0 1 2 3 40 1 2 3 40 1 2 3 4
Nausea0 1 2 3 40 1 2 3 40 1 2 3 4
Anorexia/early satiety0 1 2 3 40 1 2 3 40 1 2 3 4
Bloating/distension0 1 2 3 40 1 2 3 40 1 2 3 4
Abdominal pain0 1 2 3 40 1 2 3 40 1 2 3 4
Total GI symptom scoreSum of above Sum of above  Sum of above 

The total symptom score instrument is used as a patient-reported outcomes tool. Rated as 0 to 4, none to worse and total (0–20).

GI, gastrointestinal.

Adapted from Cutts T, et al. BMC Gastroenterol 2016;16:107.33


Gut and Liver

Vol.15 No.6
November, 2021

pISSN 1976-2283
eISSN 2005-1212

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