A critical review of the current clinical landscape of gastroparesis
Gastroparesis has emerged as a common gastrointestinal disorder over the past few decades. It has been questioned whether this increase in prevalence reflects a true epidemic or rather the mislabeling of a variety of entities of similar symptomatology accompanied by a delay in the emptying of a meal from the stomach on a radionuclide gastric emptying study. Several factors contribute to this diagnostic morass, including a failure to recognize other conditions with similar symptoms, the relative convenience and accessibility of gastric emptying tests, the pervasive presence of some delay in gastric emptying in a variety of functional gastrointestinal disorders, and the confounding effects of certain therapies (opioids in particular) on gastric emptying rates. As a consequence, the label gastroparesis is affixed to patients whose symptoms have little to do with the rate at which food leaves the stomach and initiates a misdirected course of treatment that includes prokinetics, gastric electrical stimulation, and surgery. This strategy has already led to several well-documented therapeutic failures. When evaluating patients with upper gastrointestinal symptoms, the many facets of gastric and duodenal physiology that could contribute to symptoms should be considered, and a rush to attribute them to delayed gastric emptying should be resisted, as the subset of patients with accurately diagnosed gastroparesis is small. This opinion piece critically reviews the clinical landscape of gastroparesis as well as attempts to outline what should and should not be defined as clinically important gastroparesis.