Gastroparesis in the 2020s: New Treatments, New Paradigms

Overview

Journal Curr Gastroenterol Rep

Specialty Gastroenterology

Date 2020 Mar 21

PMID 32193707

Citations 12

Authors

Amol Sharma

Michael Coles

Henry P Parkman

Affiliations

Soon will be listed here.

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. 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.

Citing Articles

Electroceuticals and Magnetoceuticals in Gastroenterology.

Song G, Sclocco R, Sharma A, Guerrero-Lopez I, Kuo B Biomolecules. 2024; 14(7).

PMID: 39062474 PMC: 11275046. DOI: 10.3390/biom14070760.

Applications of gastric peroral endoscopic myotomy in the treatment of upper gastrointestinal tract disease.

Chang S, Jin G, Sun H, Yang D, Tang T World J Gastrointest Surg. 2024; 16(3):658-669.

PMID: 38577089 PMC: 10989344. DOI: 10.4240/wjgs.v16.i3.658.

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

Mandarino F, Testoni S, Barchi A, Azzolini F, Sinagra E, Pepe G Life (Basel). 2023; 13(8).

PMID: 37629600 PMC: 10455809. DOI: 10.3390/life13081743.

Gastroparesis-Related Symptoms in Patients With Type 2 Diabetes Mellitus: Early Detection, Risk Factors, and Prevalence.

Asghar S, Asghar S, Shahid S, Sajjad H, Nasir J, Usman M Cureus. 2023; 15(3):e35787.

PMID: 37025723 PMC: 10072787. DOI: 10.7759/cureus.35787.

Using an Endoluminal Functional Lumen Imaging Probe (EndoFLIP™) to Compare Pyloric Function in Patients with Gastroparesis to Patients After Esophagectomy.

Lorenz F, Brunner S, Berlth F, Dratsch T, Babic B, Fuchs H J Gastrointest Surg. 2022; 27(4):682-690.

PMID: 36376723 PMC: 10073042. DOI: 10.1007/s11605-022-05502-x.

References

Camilleri M, Chedid V, Ford A, Haruma K, Horowitz M, Jones K . Gastroparesis. Nat Rev Dis Primers. 2018; 4(1):41. DOI: 10.1038/s41572-018-0038-z. View

Hibbard M, Dunst C, Swanstrom L . Laparoscopic and endoscopic pyloroplasty for gastroparesis results in sustained symptom improvement. J Gastrointest Surg. 2011; 15(9):1513-9. DOI: 10.1007/s11605-011-1607-6. View

Soota K, Kedar A, Nikitina Y, Arendale E, Vedanarayanan V, Abell T . Immunomodulation for treatment of drug and device refractory gastroparesis. Results Immunol. 2016; 6:11-4. PMC: 4792859. DOI: 10.1016/j.rinim.2016.02.001. View

Rodriguez L, Rodriguez P, Gomez B, Ayala J, Saba J, Perez-Castilla A . Electrical stimulation therapy of the lower esophageal sphincter is successful in treating GERD: final results of open-label prospective trial. Surg Endosc. 2012; 27(4):1083-92. PMC: 3599161. DOI: 10.1007/s00464-012-2561-4. View

Lee A, Rao S, Nguyen L, Moshiree B, Sarosiek I, Schulman M . Validation of Diagnostic and Performance Characteristics of the Wireless Motility Capsule in Patients With Suspected Gastroparesis. Clin Gastroenterol Hepatol. 2018; 17(9):1770-1779.e2. PMC: 7442471. DOI: 10.1016/j.cgh.2018.11.063. View

Kamm M, Dudding T, Melenhorst J, Jarrett M, Wang Z, Buntzen S . Sacral nerve stimulation for intractable constipation. Gut. 2010; 59(3):333-40. DOI: 10.1136/gut.2009.187989. View

Bernard C, Gibbons S, Mann I, Froschauer L, Parkman H, Harbison S . Association of low numbers of CD206-positive cells with loss of ICC in the gastric body of patients with diabetic gastroparesis. Neurogastroenterol Motil. 2014; 26(9):1275-84. PMC: 4149814. DOI: 10.1111/nmo.12389. View

Davis B, Sarosiek I, Bashashati M, Alvarado B, McCallum R . The Long-Term Efficacy and Safety of Pyloroplasty Combined with Gastric Electrical Stimulation Therapy in Gastroparesis. J Gastrointest Surg. 2016; 21(2):222-227. DOI: 10.1007/s11605-016-3327-4. View

Zikos T, Kamal A, Neshatian L, Triadafilopoulos G, Clarke J, Nandwani M . High Prevalence of Slow Transit Constipation in Patients With Gastroparesis. J Neurogastroenterol Motil. 2019; 25(2):267-275. PMC: 6474696. DOI: 10.5056/jnm18206. View

10.

Friedenberg F, Palit A, Parkman H, Hanlon A, Nelson D . Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2007; 103(2):416-23. DOI: 10.1111/j.1572-0241.2007.01676.x. View

11.

Herring B, Hoggatt A, Gupta A, Griffith S, Nakeeb A, Choi J . Idiopathic gastroparesis is associated with specific transcriptional changes in the gastric muscularis externa. Neurogastroenterol Motil. 2017; 30(4):e13230. PMC: 5878698. DOI: 10.1111/nmo.13230. View

12.

Reddymasu S, Sarosiek I, McCallum R . Severe gastroparesis: medical therapy or gastric electrical stimulation. Clin Gastroenterol Hepatol. 2009; 8(2):117-24. DOI: 10.1016/j.cgh.2009.09.010. View

13.

Camilleri M, Parkman H, Shafi M, Abell T, Gerson L . Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2012; 108(1):18-37. PMC: 3722580. DOI: 10.1038/ajg.2012.373. View

14.

Choi K, Gibbons S, Nguyen T, Stoltz G, Lurken M, Ordog T . Heme oxygenase-1 protects interstitial cells of Cajal from oxidative stress and reverses diabetic gastroparesis. Gastroenterology. 2008; 135(6):2055-64, 2064.e1-2. PMC: 2796242. DOI: 10.1053/j.gastro.2008.09.003. View

15.

Arts J, Holvoet L, Caenepeel P, Bisschops R, Sifrim D, Verbeke K . Clinical trial: a randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007; 26(9):1251-8. DOI: 10.1111/j.1365-2036.2007.03467.x. View

16.

Kuo B, McCallum R, Koch K, Sitrin M, Wo J, Chey W . Comparison of gastric emptying of a nondigestible capsule to a radio-labelled meal in healthy and gastroparetic subjects. Aliment Pharmacol Ther. 2007; 27(2):186-96. DOI: 10.1111/j.1365-2036.2007.03564.x. View

17.

Pasricha P, Colvin R, Yates K, Hasler W, Abell T, Unalp-Arida A . Characteristics of patients with chronic unexplained nausea and vomiting and normal gastric emptying. Clin Gastroenterol Hepatol. 2011; 9(7):567-76.e1-4. PMC: 3123425. DOI: 10.1016/j.cgh.2011.03.003. View

18.

Jehangir A, Parkman H . Cannabinoid Use in Patients With Gastroparesis and Related Disorders: Prevalence and Benefit. Am J Gastroenterol. 2019; 114(6):945-953. DOI: 10.14309/ajg.0000000000000181. View

19.

Brini M, Carafoli E . Calcium pumps in health and disease. Physiol Rev. 2009; 89(4):1341-78. DOI: 10.1152/physrev.00032.2008. View

20.

Sanders K, Kito Y, Hwang S, Ward S . Regulation of Gastrointestinal Smooth Muscle Function by Interstitial Cells. Physiology (Bethesda). 2016; 31(5):316-26. PMC: 5504460. DOI: 10.1152/physiol.00006.2016. View