Expert Commentary: Algorithm for the Treatment of Gastroparesis
Gastroparesis is an increasingly common problem. It has many causes and thorough evaluation is required. Mechanical obstruction and nonsurgically correctable causes need to be ruled out or treated appropriately if present. Dietary manipulation and medical therapy are the mainstays of treatment. Patients with intractable symptoms can be considered for surgical therapy. Patients with postvagotomy or postgastrectomy gastroparesis can be treated with near-total gastrectomy. Patients with idiopathic or diabetic gastroparesis who do not take narcotics and have emesis and nausea as the primary cause can be treated with gastric neurostimulation. Patients with other causes can be treated with pyloroplasty. Despite this, persistent symptoms are common, and the clinician needs to establish a long-term relationship with these patients.