Imaging in Gastroparesis: Exploring Innovative Diagnostic Approaches, Symptoms, and Treatment

Abstract

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.

Precision Endoscopy in Peroral Myotomies for Motility Disorders of the Upper Gastrointestinal Tract: Current Insights and Prospective Avenues—A Comprehensive Review

“…The efficacy of G-POEM is defined as clinical improvement, as measured recently by a one-point decrease in the GCSI score with a ≥25% decrease in two subscales [68].…”

“…The gastric emptying study (GES) is the gold standard for GP diagnosis, although other diagnostic techniques have been recently validated for clinical practice, including wireless motility capsules (WMCs) and the 13C-breath test for GE [67,68].…”

“…GP pathogenesis is not yet well defined. Multiple mechanisms contribute to the complex pathophysiology of the disorder, including vagal nerve dysfunction, visceral hypersensivity, impaired fundic accommodation (FA), antral hypomotility, gastric dysrhythmias, and increased pylorus tone, defined as "pylorospasm" [68]. It has been speculated that the microbiota and duodenal dysbiosis influence the development of GP [69], as seen in other gastrointestinal diseases [70][71][72][73].…”