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Gastroparesis in the 2020s: New Treatments, New Paradigms

  • Neuromuscular Disorders of the Gastrointestinal Tract (S Rao, Section Editor)
  • Published:
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Abstract

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-enteric autoimmune and/or autonomic disorder with macrophage imbalance. The development of newer techniques to assess gastric emptying (gastric emptying breath test and wireless motility capsule) and pyloric distensibility (EndoFLIP®) are allowing clinicians better characterization of their patients. In addition to pharmaceutical compounds in the pipeline, neuromodulation and endosurgical techniques, such as G-POEM, may help address refractory Gp.

Summary

We expect that the 2020 decade will witness exciting developments. Treatments targeting gastrointestinal motility, immunological dysfunction, and inflammatory mediators will be evaluated. We anticipate future studies will be guided by biomarkers correlated with patient outcomes and therapeutic efficacy to establish new paradigms in the management of Gp.

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Abbreviations

Gp:

Gastroparesis

GI:

Gastrointestinal

CUNV:

Chronic unexplained nausea and vomiting

GERD:

Gastroesophageal reflux disease

ICC:

Interstitial cells of Cajal

SMC:

Smooth muscle cells

GES:

Gastric emptying scintigraphy

GEBT:

Gastric emptying breath test

WMC:

Wireless motility capsule

G-POEM:

Gastric peroral endoscopic myotomy

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Camilleri M, Parkman HP, Shafi MA, et al. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013;108:18–37 quiz 38.

    Article  CAS  PubMed  Google Scholar 

  2. Jung HK, Choung RS, Locke GR 3rd, et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136:1225–33.

    Article  PubMed  Google Scholar 

  3. Navas CM, Patel NK, Lacy BE. Gastroparesis: medical and therapeutic advances. Dig Dis Sci. 2017;62:2231–40.

    Article  PubMed  Google Scholar 

  4. Rey E, Choung RS, Schleck CD, Zinsmeister AR, Talley NJ, Locke GR 3rd. Prevalence of hidden gastroparesis in the community: the gastroparesis "iceberg". J Neurogastroenterol Motil. 2012;18:34–42.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Forouhi NG, Wareham NJ. Epidemiology of diabetes. Medicine (Abingdon). 2014;42:698–702.

    Google Scholar 

  6. Wang YR, Fisher RS, Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995-2004. Am J Gastroenterol. 2008;103:313–22.

    Article  PubMed  Google Scholar 

  7. Yu D, Ramsey FV, Norton NJ, et al. Mo1581 impaired quality of life in Gastroparesis: relationships to symptoms of gastroparesis. Gastroenterology. 2016;150:S718.

    Article  Google Scholar 

  8. Sanders KM, Kito Y, Hwang SJ, Ward SM. Regulation of gastrointestinal smooth muscle function by interstitial cells. Physiology. 2016;31:316–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  9. Brini M, Carafoli E. Calcium pumps in health and disease. Physiol Rev. 2009;89:1341–78.

    Article  CAS  PubMed  Google Scholar 

  10. Kelly JP, DeVore AD, Wu J, et al. Rhythm control versus rate control in patients with atrial fibrillation and heart failure with preserved ejection fraction: insights from get with the guidelines-heart failure. J Am Heart Assoc. 2019;8:e011560.

    PubMed  PubMed Central  Google Scholar 

  11. Bernard C, Gibbons SJ, Mann IS, Froschauer L, Parkman HP, Harbison S, et al. Association of low numbers of CD 206-positive cells with loss of ICC in the gastric body of patients with diabetic gastroparesis. Neurogastroenterol Motil. 2014;26:1275–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Herring BP, Hoggatt AM, Gupta A, et al. Idiopathic gastroparesis is associated with specific transcriptional changes in the gastric muscularis externa. Neurogastroenterol Motil. 2018;30:e13230.

    Article  CAS  PubMed  Google Scholar 

  13. Choi KM, Gibbons SJ, Nguyen TV, et al. Heme oxygenase-1 protects interstitial cells of Cajal from oxidative stress and reverses diabetic gastroparesis. Gastroenterology. 2008;135:2055–64 2064 e1–2.

    Article  CAS  PubMed  Google Scholar 

  14. Grover M, Bernard CE, Pasricha PJ, et al. Diabetic and idiopathic gastroparesis is associated with loss of CD206-positive macrophages in the gastric antrum. Neurogastroenterol Motil 2017;29.

  15. Cipriani G, Gibbons SJ, Verhulst PJ, Choi KM, Eisenman ST, Hein SS, et al. Diabetic Csf1(op/op) mice lacking macrophages are protected against the development of delayed gastric emptying. Cell Mol Gastroenterol Hepatol. 2016;2:40–7.

    Article  PubMed  Google Scholar 

  16. Sharma A, Parkman HP, Thomas R. Myenteric ganglionitis in gastroparesis. Gastroenterology. 2011;140:S-71.

    Article  Google Scholar 

  17. Flanagan EP, Saito YA, Lennon VA, McKeon A, Fealey RD, Szarka LA, et al. Immunotherapy trial as diagnostic test in evaluating patients with presumed autoimmune gastrointestinal dysmotility. Neurogastroenterol Motil. 2014;26:1285–97.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Soota K, Kedar A, Nikitina Y, Arendale E, Vedanarayanan V, Abell TL. Immunomodulation for treatment of drug and device refractory gastroparesis. Res Immunol. 2016;6:11–4.

    Article  Google Scholar 

  19. Singla R, Homko C, Schey R, Parkman HP. Diabetes-related autoantibodies in diabetic gastroparesis. Dig Dis Sci. 2015;60:1733–7.

    Article  CAS  PubMed  Google Scholar 

  20. Nguyen LAB, Wilson L, Hasler WL, et al. Autonomic function in Gastroparesis: relationship with etiology. Gastric Emptying Symptom Severity Gastroenterol. 2017;152:S121.

    Google Scholar 

  21. Yolsuriyanwong K, Marcotte E, Venu M, Chand B. Impact of vagus nerve integrity testing on surgical management in patients with previous operations with potential risk of vagal injury. Surg Endosc. 2019;33:2620–8.

    Article  PubMed  Google Scholar 

  22. van Rijn S, Roebroek YG, Conchillo JM, Bouvy ND, Masclee AA. Effect of vagus nerve injury on the outcome of antireflux surgery: an extensive literature review. Dig Surg. 2016;33:230–9.

    Article  PubMed  Google Scholar 

  23. Desprez C, Melchior C, Wuestenberghs F, et al. Pyloric distensibility measurement after gastric surgery: which surgeries are associated with pylorospasm? Neurogastroenterol Motil. 2020;8:e13790.

    Google Scholar 

  24. Parkman HP, Hasler WL, Fisher RS, American Gastroenterological Association. American Gastroenterological Association technical review on the diagnosis and treatment of gastroparesis. Gastroenterology. 2004;127:1592–622.

    Article  PubMed  Google Scholar 

  25. Shahsavari D, Yu D, Jehangir A, et al. Symptom variability throughout the day in patients with gastroparesis. Neurogastroenterol Motil. 2019;32(2):e13740.

    PubMed  Google Scholar 

  26. Soykan I, Sivri B, Sarosiek I, Kiernan B, McCallum R. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43:2398–404.

    Article  CAS  PubMed  Google Scholar 

  27. Parkman HP, Hallinan EK, Hasler WL, et al. Early satiety and postprandial fullness in gastroparesis correlate with gastroparesis severity, gastric emptying, and water load testing. Neurogastroenterol Motil. 2017;29:e12981.

    Article  Google Scholar 

  28. Hasler W, Wilson L, Parkman H, et al. Factors related to abdominal pain in gastroparesis: contrast to patients with predominant nausea and vomiting. Neurogastroenterol Motil. 2013;25:427–e301.

    Article  CAS  PubMed  Google Scholar 

  29. Parkman HP, Wilson LA, Hasler WL, McCallum R, Sarosiek I, Koch KL, et al. Abdominal pain in patients with Gastroparesis: associations with gastroparesis symptoms, etiology of gastroparesis, gastric emptying, somatization, and quality of life. Dig Dis Sci. 2019;64:2242–55.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Parkman HP, Yates K, Hasler WL, Nguyen L, Pasricha PJ, Snape WJ, et al. Cholecystectomy and clinical presentations of gastroparesis. Dig Dis Sci. 2013;58:1062–73.

    Article  PubMed  Google Scholar 

  31. Parkman HP, Van Natta ML, Abell TL, et al. Effect of nortriptyline on symptoms of idiopathic gastroparesis: the NORIG randomized clinical trial. Jama. 2013;310:2640–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Siegfried WY, Rattanakovit K, Mack A, et al. Su1454 Is gastroparesis a pan-enteric neuropathic disorder: investigation with wireless motility capsule. Gastroenterology. 2015;148:S-516–7.

    Google Scholar 

  33. • Lee AA, Rao S, Nguyen LA, et al. Validation of diagnostic and performance characteristics of the wireless motility capsule in patients with suspected gastroparesis. Clin Gastroenterol Hepatol. 2019;17:1770–9 e2. Study showing increased yield of wireless motility capsule over gastric emptying scintigraphy, although still only 35%.

    Article  PubMed  Google Scholar 

  34. Zikos TA, Kamal AN, Neshatian L, et al. High prevalence of slow transit constipation in patients with gastroparesis. J Neurogastroenterol Motil. 2019;25:267–75.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Sharma A, Rao S. Constipation: pathophysiology and current therapeutic approaches. Handb Exp Pharmacol. Gastrointestinal Pharmacology: Springer. 2016;239:59–74.

    Article  CAS  Google Scholar 

  36. Camilleri M, Chedid V, Ford AC, et al. Gastroparesis. Nat Rev Dis Primers. 2018;4:41.

    Article  PubMed  Google Scholar 

  37. Abell TL, Camilleri M, Donohoe K, Hasler WL, Lin HC, Maurer AH, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility society and the Society of Nuclear Medicine. J Nucl Med Technol. 2008;36:44–54.

    Article  PubMed  Google Scholar 

  38. Tougas G, Eaker EY, Abell TL, Abrahamsson H, Boivin M, Chen J, et al. Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol. 2000;95:1456–62.

    Article  CAS  PubMed  Google Scholar 

  39. Bharucha AE, Camilleri M, Forstrom LA, Zinsmeister AR. Relationship between clinical features and gastric emptying disturbances in diabetes mellitus. Clin Endocrinol. 2009;70:415–20.

    Article  Google Scholar 

  40. Parkman HP, Yates KP, McCallum RW, et al. 143-Gastric emptying changes over time in gastroparesis: comparison of initial and 48 week follow up gastric emptying tests in the gastroparesis registry of the gastroparesis consortium. Gastroenterology. 2018;154:S-39.

    Article  Google Scholar 

  41. Orthey P, Parkman H, Maurer A. Assessment of gastric fundic accommodation using physiologic segmentation of the stomach with dynamic antral contraction scintigraphy (DACS) rather than anatomic division: establishing normal values. J Nucl Med. 2018;59:162.

    Article  CAS  Google Scholar 

  42. Orthey P, Yu D, Van Natta ML, et al. Intragastric meal distribution during gastric emptying scintigraphy for assessment of fundic accommodation: correlation with symptoms of gastroparesis. J Nucl Med. 2018;59:691–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Szarka LA, Camilleri M, Vella A, et al. A stable isotope breath test with a standard meal for abnormal gastric emptying of solids in the clinic and in research. Clin Gastroenterol Hepatol. 2008;6:635–43 e1.

    Article  PubMed  PubMed Central  Google Scholar 

  44. Ghoos YF, Maes BD, Geypens BJ, et al. Measurement of gastric emptying rate of solids by means of a carbon-labeled octanoic acid breath test. Gastroenterology. 1993;104:1640–7.

    Article  CAS  PubMed  Google Scholar 

  45. • Kunkel DC, Clarke JO. Murky waters for diagnosis of Gastroparesis. Clin Gastroenterol Hepatol. 2019;17:1724–5 Excellent editorial highlighting the lack of correlation with patient outcomes and therapeutic efficacy to guide potential treatments of Gp.

    Article  PubMed  Google Scholar 

  46. Shin AS, Camilleri M. Diagnostic assessment of diabetic gastroparesis. Diabetes. 2013;62:2667–73.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  47. Kuo B, McCallum R, Koch K, Sitrin MD, Wo JM, Chey WD, et al. Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2008;27:186–96.

    Article  CAS  PubMed  Google Scholar 

  48. •• Cassilly D, Kantor S, Knight L, et al. Gastric emptying of a non-digestible solid: assessment with simultaneous SmartPill pH and pressure capsule, antroduodenal manometry, gastric emptying scintigraphy. Neurogastroenterol Motil. 2008;20:311–9 Study demonstrating emptying of wireless motility capsule corresponds with phase III migrating motor complex more than gastric emptying of scintigraphic meal.

    Article  CAS  PubMed  Google Scholar 

  49. • Pasricha PJ, Colvin R, Yates K, et al. Characteristics of patients with chronic unexplained nausea and vomiting and normal gastric emptying. Clin Gastroenterol Hepatol. 2011;9(7):567–76 e1-4. Study showing patients with chronic unexplained nausea and vomiting (CUNV) are indistiguishable from gastroparesis patients.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Anudeep V, Vinod KV, Pandit N, Sharma VK, Dhanapathi H, Dutta TK, et al. Prevalence and predictors of delayed gastric emptying among Indian patients with long-standing type 2 diabetes mellitus. Indian J Gastroenterol. 2016;35:385–92.

    Article  PubMed  Google Scholar 

  51. Vijayvargiya P, Jameie-Oskooei S, Camilleri M, Chedid V, Erwin PJ, Murad MH. Association between delayed gastric emptying and upper gastrointestinal symptoms: a systematic review and meta-analysis. Gut. 2019;68:804–13.

    Article  PubMed  Google Scholar 

  52. Ehrenpreis ED, Deepak P, Sifuentes H, et al. The metoclopramide black box warning for tardive dyskinesia: effect on clinical practice, adverse event reporting, and prescription drug lawsuits. Am J Gastroenterol. 2013;108:866.

    Article  CAS  PubMed  Google Scholar 

  53. • Al-Saffar A, Lennernäs H, Hellström PM. Gastroparesis, metoclopramide, and tardive dyskinesia: risk revisited. Neurogastroenterol Motil. 2019;2:e13617 Study illustrating true incidence of tardive dyskinesia with metoclopromide much lower than FDA estimated 1–10%.

    Google Scholar 

  54. •• Vijayvargiya P, Camilleri M, Chedid V, et al. Effects of promotility agents on gastric emptying and symptoms: a systematic review and meta-analysis. Gastroenterology. 2019;156:1650–60 Meta-analysis demonstrating that gastric emptying from gastric emptying scintigraphy following optimal protocols correlates with symptoms and symptom improvement after treatment with promotility agents correlates with improvement in gastric emptying.

    Article  CAS  PubMed  Google Scholar 

  55. Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol. 2019;114:1265–74.

    Article  PubMed  Google Scholar 

  56. Abell T, Kuo B, Esfandyari T, et al. 784–Velusetrag improves gastoparesis both in symptoms and gastric emptying in patients with diabetic or idiopathic gastroparesis in a 12-week global phase 2B study. Gastroenterology. 2019;156:S-164.

    Article  Google Scholar 

  57. Midani D, Parkman HP. Granisetron transdermal system for treatment of symptoms of gastroparesis: a prescription registry study. J Neurogastroenterol Motil. 2016;22:650–5.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Liu T, Ji R-R. New insights into the mechanisms of itch: are pain and itch controlled by distinct mechanisms? Pflügers Archiv-Eur J Physiol. 2013;465:1671–85.

    Article  CAS  Google Scholar 

  59. Pasricha PJ, Yates K, Sarosiek I, et al. Aprepitant for symptoms of Gastroparesis and related disorders: the APRON randomized clinical trial: 1100. Am J Gastroenterol. 2016;111:S480–1.

    Article  Google Scholar 

  60. Jacob DA, Busciglio I, Burton D, et al. A randomized, placebo-controlled trial of the effects of aprepitant, an NK1 receptor antagonist, on gastric motor functions and satiation in healthy volunteers: 1210. Am J Gastroenterol. 2017;112:S663–4.

    Article  Google Scholar 

  61. Carlin JL, Lieberman VR, Dahal A, et al. Tradipitant complete responder analysis in gastroparesis patients: 1238. Am J Gastroenterol. 2019;114:S691.

    Article  Google Scholar 

  62. Harrison S, Abdelmalek M, Trotter J, et al. NGM282, a novel variant of FGF19, significantly reduces hepatic steatosis and key biomarkers of NASH: results of a phase 2, multicenter, randomized, double-blinded, placebo controlled trial in biopsy-confirmed NASH patients. J Hepatol. 2017;66:S92–3.

    Article  Google Scholar 

  63. Mayo MJ, Wigg AJ, Thompson A, et al. Impact of NGM282 on the incidence and severity of pruritus in primary biliary cirrhosis patients and correlations with liver chemistries and serum bile acids. Hepatology. 2015;62:520A–1A.

    Google Scholar 

  64. Oduyebo I, Camilleri M, Nelson AD, Khemani D, Nord SL, Busciglio I, et al. Open: effects of NGM282, an FGF19 variant, on colonic transit and bowel function in functional constipation: a randomized phase 2 trial. Am J Gastroenterol. 2018;113:725–34.

    Article  CAS  PubMed  Google Scholar 

  65. Nelson AD, Camilleri M, Acosta A, Busciglio I, Linker Nord S, Boldingh A, et al. Effects of ghrelin receptor agonist, relamorelin, on gastric motor functions and satiation in healthy volunteers. Neurogastroenterol Motil. 2016;28:1705–13.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. Camilleri M, McCallum RW, Tack J, et al. Efficacy and safety of relamorelin in diabetics with symptoms of gastroparesis: a randomized, placebo-controlled study. Gastroenterology. 2017;153:1240–50 e2.

    Article  CAS  PubMed  Google Scholar 

  67. Jehangir A, Parkman HP. Cannabinoid use in patients with gastroparesis and related disorders: prevalence and benefit. Am J Gastroenterol. 2019;114:945–53.

    Article  PubMed  Google Scholar 

  68. Abell T, McCallum R, Hocking M, Koch K, Abrahamsson H, Leblanc I, et al. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology. 2003;125:421–8.

    Article  PubMed  Google Scholar 

  69. Wexner SD, Coller JA, Devroede G, Hull T, McCallum R, Chan M, et al. Sacral nerve stimulation for fecal incontinence: results of a 120-patient prospective multicenter study. Ann Surg. 2010;251:441–9.

    Article  PubMed  Google Scholar 

  70. Rodríguez L, Rodriguez P, Gómez B, Ayala JC, Saba J, Perez-Castilla A, et al. Electrical stimulation therapy of the lower esophageal sphincter is successful in treating GERD: final results of open-label prospective trial. Surg Endosc. 2013;27:1083–92.

    Article  PubMed  Google Scholar 

  71. Kamm MA, Dudding TC, Melenhorst J, Jarrett M, Wang Z, Buntzen S, et al. Sacral nerve stimulation for intractable constipation. Gut. 2010;59:333–40.

    Article  PubMed  Google Scholar 

  72. Levinthal D, Bielefeldt K. Systematic review and meta-analysis: gastric electrical stimulation for gastroparesis. Auton Neurosci. 2017;202:45–55.

    Article  CAS  PubMed  Google Scholar 

  73. Soffer E, Abell T, Lin Z, et al. Gastric electrical stimulation for gastroparesis–physiological foundations, technical aspects and clinical implications. Aliment Pharmacol Ther. 2009;30:681–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  74. Reddymasu SC, Sarosiek I, McCallum RW. Severe gastroparesis: medical therapy or gastric electrical stimulation. Clin Gastroenterol Hepatol. 2010;8:117–24.

    Article  CAS  PubMed  Google Scholar 

  75. Gourcerol G, Huet E, Vandaele N, Chaput U, Leblanc I, Bridoux V, et al. Long term efficacy of gastric electrical stimulation in intractable nausea and vomiting. Dig Liver Dis. 2012;44:563–8.

    Article  PubMed  Google Scholar 

  76. McCallum RW, Snape W, Brody F, et al. Gastric electrical stimulation with Enterra therapy improves symptoms from diabetic gastroparesis in a prospective study. Clin Gastroenterol Hepatol. 2010;8:947–54 e1.

    Article  PubMed  Google Scholar 

  77. Davis B, Sarosiek I, Bashashati M, et al. The long-term efficacy and safety of pyloroplasty combined with gastric electrical stimulation therapy in gastroparesis. J Gastrointest Surg: official journal of the Society for Surgery of the Alimentary Tract. 2017;21:222.

    Article  Google Scholar 

  78. Tetangco EGP, Harrell S, Abboud R, et al. GOO due to gastric stimulator electrode migration: add this to your DDx of gastroparesis exacerbation: 1890. Am J Gastroenterol. 2018;113:S1072–3.

    Article  Google Scholar 

  79. Groves DA, Brown VJ. Vagal nerve stimulation: a review of its applications and potential mechanisms that mediate its clinical effects. Neurosci Biobehav Rev. 2005;29:493–500.

    Article  PubMed  Google Scholar 

  80. Paulon E, Nastou D, Jaboli F, Marin J, Liebler E, Epstein O. Proof of concept: short-term non-invasive cervical vagus nerve stimulation in patients with drug-refractory gastroparesis. Frontline Gastroenterology. 2017;8:325–30.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Gottfried-Blackmore A, Adler EP, Fernandez-Becker N, et al. Open-label pilot study: non-invasive vagal nerve stimulation improves symptoms and gastric emptying in patients with idiopathic gastroparesis. Neurogastroenterol Motil. 2019;5:e13769.

    Google Scholar 

  82. Moraveji S, Bashashati M, Elhanafi S, Sunny J, Sarosiek I, Davis B, et al. Depleted interstitial cells of Cajal and fibrosis in the pylorus: novel features of gastroparesis. Neurogastroenterol Motil. 2016;28:1048–54.

    Article  CAS  PubMed  Google Scholar 

  83. Mearin F, Camilleri M, Malagelada J-R. Pyloric dysfunction in diabetics with recurrent nausea and vomiting. Gastroenterology. 1986;90:1919–25.

    Article  CAS  PubMed  Google Scholar 

  84. Gourcerol G, Tissier F, Melchior C, Touchais JY, Huet E, Prevost G, et al. Impaired fasting pyloric compliance in gastroparesis and the therapeutic response to pyloric dilatation. Aliment Pharmacol Ther. 2015;41:360–7.

    Article  CAS  PubMed  Google Scholar 

  85. Malik Z, Sankineni A, Parkman H. Assessing pyloric sphincter pathophysiology using Endo FLIP in patients with gastroparesis. Neurogastroenterol Motil. 2015;27:524–31.

    Article  CAS  PubMed  Google Scholar 

  86. Ahuja NK, Clarke JO. Pyloric therapies for gastroparesis. Curr Treat Options Gastroenterol. 2017;15:230–40.

    Article  PubMed  Google Scholar 

  87. Arts J, Holvoet L, Caenepeel P, Bisschops R, Sifrim D, Verbeke K, et al. Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007;26:1251–8.

    Article  CAS  PubMed  Google Scholar 

  88. Friedenberg FK, Palit A, Parkman HP, et al. Botulinum toxin a for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103:416.

    Article  CAS  PubMed  Google Scholar 

  89. Khashab MA, Besharati S, Ngamruengphong S, Kumbhari V, el Zein M, Stein EM, et al. Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation (with video). Gastrointest Endosc. 2015;82:1106–9.

    Article  PubMed  Google Scholar 

  90. Hibbard ML, Dunst CM, Swanström LL. Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg. 2011;15:1513–9.

    Article  PubMed  Google Scholar 

  91. Toro JP, Lytle NW, Patel AD, et al. Efficacy of laparoscopic pyloroplasty for the treatment of gastroparesis. J Am Coll Surg. 2014;218:652–60.

    Article  PubMed  Google Scholar 

  92. Mancini SA, Angelo JL, Peckler Z, Philp FH, Farah KF. Pyloroplasty for refractory gastroparesis. Am Surg. 2015;81:738–46.

    PubMed  Google Scholar 

  93. Gonzalez JM, Lestelle V, Benezech A, Cohen J, Vitton V, Grimaud JC, et al. Gastric per-oral endoscopic myotomy with antropyloromyotomy in the treatment of refractory gastroparesis: clinical experience with follow-up and scintigraphic evaluation (with video). Gastrointest Endosc. 2017;85:132–9.

    Article  PubMed  Google Scholar 

  94. Mekaroonkamol P, Li LY, Dacha S, Xu Y, Keilin SD, Willingham FF, et al. Gastric peroral endoscopic pyloromyotomy (G-POEM) as a salvage therapy for refractory gastroparesis: a case series of different subtypes. Neurogastroenterol Motil. 2016;28:1272–7.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Division of Gastroenterology & Hepatology, Medical College of Georgia, Digestive Health Center, Augusta University, 1120 15th St, AD-2226, Augusta, GA, 30912, USA

    Amol Sharma

  2. Department of Medicine, Medical College of Georgia, Augusta University, Augusta, GA, USA

    Michael Coles

  3. Division of Gastroenterology & Hepatology, Lewis Katz School of Medicine, Temple University Hospital, Philadelphia, PA, USA

    Henry P. Parkman

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Sharma, A., Coles, M. & Parkman, H.P. Gastroparesis in the 2020s: New Treatments, New Paradigms. Curr Gastroenterol Rep 22, 23 (2020). https://doi.org/10.1007/s11894-020-00761-7

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