New Advances in Clinical Diagnosis and Management of Gastroparesis

doi:10.12114/j.issn.1007-9572.2021.00.437

Abstract

Abstract: Gastroparesis is a rare gastrointestinal motility disorder，which can be caused by many reasons，but the causative mechanism is still unclear.Gastroparesis has two main subtypes，idiopathic gastroparesis（primary）and diabetic gastroparesis（secondary），and an essential symptom of delayed gastric emptying.Diet modification and prokinetic drugs are initial treatments for gastroparesis，but how to significantly improve it is still a difficult problem.The recently emerged technologies have shed light on its diagnosis and treatment.This paper mainly summarized and analyzed new advances in clinical diagnosis and management of gastroparesis，aiming to provide a reference for clinical diagnosis and management of this disease.

Key words: Gastroparesis, Diagnosis, Therapy, Prokinetic drug, Botulinum neurotoxin, Gastroelectric stimulation, Gastric peroral endoscopic myotomy

摘要： 胃轻瘫是临床上较为少见的胃肠动力障碍疾病之一，其病因多样，发病机制尚不明确，以特发性胃轻瘫（原发性）和糖尿病胃轻瘫（继发性）多见。胃排空延迟是诊断胃轻瘫的必要条件，而改善胃轻瘫是现阶段临床难点之一。饮食调整和促动力药物是目前治疗胃轻瘫的基础，近年来新兴诊疗技术的发展为胃轻瘫的诊断和治疗提供了新思路。本文主要总结、分析了近年来胃轻瘫临床诊断和治疗方面的新进展，以期为提高临床胃轻瘫诊疗水平提供参考。

关键词: 胃肌轻瘫, 诊断, 治疗, 促动力药, 肉毒素, 胃电刺激, 经口内镜下胃幽门肌切开术

JIANG Ya,LIN Lin. New Advances in Clinical Diagnosis and Management of Gastroparesis　[J]. Chinese General Practice, 2021, 24(15): 1978-1983. DOI: 10.12114/j.issn.1007-9572.2021.00.437.
姜亚,林琳. 胃轻瘫临床诊断和治疗的新进展[J]. 中国全科医学, 2021, 24(15): 1978-1983. DOI: 10.12114/j.issn.1007-9572.2021.00.437.

References

［1］JUNG H K，CHOUNG R S，LOCKE G R 3rd，et al．The incidence，prevalence，and outcomes of patients with gastroparesis in Olmsted County，Minnesota，from 1996 to 2006［J］．Gastroenterology，2009，136（4）：1225-1233．DOI：10.1053/j.gastro.2008.12.047.
［2］REY E，CHOUNG R S，SCHLECK C D，et al．Prevalence of hidden gastroparesis in the community：the gastroparesis “iceberg”［J］．J Neurogastroenterol Motil，2012，18（1）：34-42．DOI：10.5056/jnm.2012.18.1.34.
［3］WOODHOUSE S，HEBBARD G，KNOWLES S R.Psychological controversies in gastroparesis：a systematic review［J］．World J Gastroenterol，2017，23（7）：1298-1309．DOI：10.3748/wjg.v23.i7.1298.
［4］CAMILLERI M，PARKMAN H P，SHAFI M A，et al．Clinical guideline：management of gastroparesis［J］．Am J Gastroenterol，2013，108（1）：18-37；quiz 38．DOI：10.1038/ajg.2012.373.
［5］LACY B E，PARKMAN H P，CAMILLERI M.Chronic nausea and vomiting：evaluation and treatment［J］．Am J Gastroenterol，2018，113（5）：647-659．DOI：10.1038/s41395-018-0039-2.
［6］SOYKAN I，SIVRI B，SAROSIEK I，et al．Demography，clinical characteristics，psychological and abuse profiles，treatment，and long-term follow-up of patients with gastroparesis［J］．Dig Dis Sci，1998，43（11）：2398-2404．DOI：10.1023/a：1026665728213.
［7］CHOUNG R S，LOCKE G R 3rd，SCHLECK C D，et al．Risk of gastroparesis in subjects with type 1 and 2 diabetes in the general population［J］．Am J Gastroenterol，2012，107（1）：82-88．DOI：10.1038/ajg.2011.310.
［8］CAMILLERI M，BHARUCHA A E，FARRUGIA G.Epidemiology，mechanisms，and management of diabetic gastroparesis［J］．Clin Gastroenterol Hepatol，2011，9（1）：5-12；quiz e7．DOI：10.1016/j.cgh.2010.09.022.
［9］CAMILLERI M，ITURRINO J，BHARUCHA A E，et al．Performance characteristics of scintigraphic measurement of gastric emptying of solids in healthy participants［J］．Neurogastroenterol Motil，2012，24（12）：1076-e562．DOI：10.1111/j.1365-2982.2012.01972.x.
［10］CAMILLERI M，ZINSMEISTER A R，GREYDANUS M P，et al．Towards a less costly but accurate test of gastric emptying and small bowel transit［J］．Dig Dis Sci，1991，36（5）：609-615．DOI：10.1007/BF01297027.
［11］ABELL T L，CAMILLERI M，DONOHOE K，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］．J Nucl Med Technol，2008，31（1）：44-54．DOI：10.2967/jnmt.107.048116.
［12］CHEN J D，LIN Z，PAN J，et al．Abnormal gastric myoelectrical activity and delayed gastric emptying in patients with symptoms suggestive of gastroparesis［J］．Dig Dis Sci，1996，41（8）：1538-1545．DOI：10.1007/BF02087897.
［13］CAMILLERI M，CHEDID V，FORD A C，et al．Gastroparesis［J］．Nat Rev Dis Primers，2018，4（1）：41．DOI：10.1038/s41572-018-0038-z.
［14］TOUGAS G，EAKER E Y，ABELL T L，et al．Assessment of gastric emptying using a low fat meal：establishment of international control values［J］．Am J Gastroenterol，2000，95（6）：1456-1462.
［15］ORTHEY P，YU D，VAN NATTA M L，et al．Intragastric meal distribution during gastric emptying scintigraphy for assessment of fundic accommodation：correlation with symptoms of gastroparesis［J］．J Nucl Med，2018，59（4）：691-697．DOI：10.2967/jnumed.117.197053.
［16］KINDT S，TACK J.Impaired gastric accommodation and its role in dyspepsia［J］．Gut，2006，55（12）：1685-1691．DOI：10.1136/gut.2005.085365.
［17］VOSOUGHI K，ICHKHANIAN Y，JACQUES J，et al．Role of endoscopic functional luminal imaging probe in predicting the outcome of gastric peroral endoscopic pyloromyotomy（with video）［J］．Gastrointest Endosc，2020，91（6）：1289-1299．DOI：10.1016/j.gie.2020.01.044.
［18］WARD M P，GUPTA A，WO J M，et al．An emerging method to noninvasively measure and identify vagal response markers to enable bioelectronic control of gastroparesis symptoms with gastric electrical stimulation［J］．J Neurosci Methods，2020，336：108631．DOI：10.1016/j.jneumeth.2020.108631.
［19］STANGHELLINI V，CHAN F K L，HASLER W L，et al．Gastroduodenal disorders［J］．Gastroenterology，2016，150（6）：1380-1392．DOI：10.1053/j.gastro.2016.02.011.
［20］LACY B E.Functional dyspepsia and gastroparesis：one disease or two？［J］．Am J Gastroenterol，2012，107（11）：1615-1620．DOI：10.1038/ajg.2012.104.
［21］CHIAL H J，CAMILLERI M，WILLIAMS D E，et al．Rumination syndrome in children and adolescents：diagnosis，treatment，and prognosis［J］．Pediatrics，2003，111（1）：158-162．DOI：10.1542/peds.111.1.158.
［22］ALLEN J H，DE MOORE G M，HEDDLE R，et al．Cannabinoid hyperemesis：cyclical hyperemesis in association with chronic cannabis abuse［J］．Gut，2004，53（11）：1566-1570．DOI：10.1136/gut.2003.036350.
［23］SAGAR R C，SOOD R，GRACIE D J，et al．Cyclic vomiting syndrome is a prevalent and under-recognized condition in the gastroenterology outpatient clinic［J］．Neurogastroenterol Motil，2018，30（1）：e13174．DOI：10.1111/nmo.13174.
［24］JANSSEN P，HARRIS M S，JONES M，et al．The relation between symptom improvement and gastric emptying in the treatment of diabetic and idiopathic gastroparesis［J］．Am J Gastroenterol，2013，108（9）：1382-1391．DOI：10.1038/ajg.2013.118.
［25］SHEN S，XU J，LAMM V，et al．Diabetic gastroparesis and nondiabetic gastroparesis［J］．Gastrointest Endosc Clin N Am，2019，29（1）：15-25．DOI：10.1016/j.giec.2018.08.002.
［26］HOMKO C J，DUFFY F，FRIEDENBERG F K，et al．Effect of dietary fat and food consistency on gastroparesis symptoms in patients with gastroparesis［J］．Neurogastroenterol Motil，2015，27（4）：501-508．DOI：10.1111/nmo.12519.
［27］VANORMELINGEN C，TACK J，ANDREWS C N.Diabetic gastroparesis［J］．Br Med Bull，2013，105：213-230．DOI：10.1093/bmb/ldt003.
［28］TACK J.Prokinetics and fundic relaxants in upper functional GI disorders［J］．Curr Opin Pharmacol，2008，8（6）：690-696．DOI：10.1016/j.coph.2008.09.009.
［29］UKLEJA A，TANDON K，SHAH K，et al．Endoscopic botox injections in therapy of refractory gastroparesis［J］．World J Gastrointest Endosc，2015，7（8）：790-798．DOI：10.4253/wjge.v7.i8.790.
［30］GROVER M，FARRUGIA G，STANGHELLINI V.Gastroparesis：a turning point in understanding and treatment［J］．Gut，2019，68（12）：2238-2250．DOI：10.1136/gutjnl-2019-318712.
［31］PARKMAN H P，CAMILLERI M，FARRUGIA G，et al．Gastroparesis and functional dyspepsia：excerpts from the AGA/ANMS meeting［J］．Neurogastroenterol Motil，2010，22（2）：113-133．DOI：10.1111/j.1365-2982.2009.01434.x.
［32］PARKMAN H P.Idiopathic gastroparesis［J］．Gastroenterol Clin North Am，2015，44（1）：59-68．DOI：10.1016/j.gtc.2014.11.015.
［33］LIU N，ABELL T.Gastroparesis updates on pathogenesis and management［J］．Gut Liver，2017，11（5）：579-589．DOI：10.5009/gnl16336.
［34］SOOTA K，KEDAR A，NIKITINA Y，et al．Immunomodulation for treatment of drug and device refractory gastroparesis［J］．Results Immunol，2016，6：11-14．DOI：10.1016/j.rinim.2016.02.001.
［35］TACK J.The difficult patient with gastroparesis［J］．Best Pract Res Clin Gastroenterol，2007，21（3）：379-391．DOI：10.1016/j.bpg.2007.01.002.
［36］BHAYANI N H，SHARATA A M，DUNST C M，et al．End of the road for a dysfunctional end organ：laparoscopic gastrectomy for refractory gastroparesis［J］．J Gastrointest Surg，2015，19（3）：411-417．DOI：10.1007/s11605-014-2609-y.
［37］MILLER L S，SZYCH G A，KANTOR S B，et al．Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle［J］．Am J Gastroenterol，2002，97（7）：1653-1660．DOI：10.1111/j.1572-0241.2002.05823.x.
［38］JAMES A N，RYAN J P，PARKMAN H P.Inhibitory effects of botulinum toxin on pyloric and antral smooth muscle［J］．Am J Physiol Gastrointest Liver Physiol，2003，285（2）：G291-297．DOI：10.1152/ajpgi.00296.2002.
［39］COLESKI R，ANDERSON M A，HASLER W L.Factors associated with symptom response to pyloric injection of botulinum toxin in a large series of gastroparesis patients［J］．Dig Dis Sci，2009，54（12）：2634-2642．DOI：10.1007/s10620-008-0660-9.
［40］BROMER M Q，FRIEDENBERG F，MILLER L S，et al．Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis［J］．Gastrointest Endosc，2005，61（7）：833-869．DOI：10.1016/s0016-5107（05）00328-7.
［41］THOMAS A，DE SOUZA RIBEIRO B，MALESPIN M，et al．Botulinum toxin as a treatment for refractory gastroparesis：a literature review［J］．Curr Treat Options Gastroenterol，2018，16（4）：479-488．DOI：10.1007/s11938-018-0187-x.
［42］KHASHAB M A，BESHARATI S，NGAMRUENGPHONG S，et al．Refractory gastroparesis can be successfully managed with endoscopic transpyloric stent placement and fixation（with video）［J］．Gastrointest Endosc，2015，82（6）：1106-1109．DOI：10.1016/j.gie.2015.06.051.
［43］CAMILLERI M.Novel diet，drugs and gastric interventions for gastroparesis［J］．Clin Gastroenterol Hepatol，2016，14（8）：1072-1080．DOI：10.1016/j.cgh.2015.12.033.
［44］ABELL T，MCCALLUM R，HOCKING M，et al．Gastric electrical stimulation for medically refractory gastroparesis［J］．Gastroenterology，2003，125（2）：421-428．DOI：10.1016/s0016-5085（03）00878-3.
［45］MARANKI J L，LYTES V，MEILAHN J E，et al．Predictive factors for clinical improvement with Enterra gastric electric stimulation treatment for refractory gastroparesis［J］．Dig Dis Sci，2008，53（8）：2072-2078．DOI：10.1007/s10620-007-0124-7.
［46］LAL N，LIVEMORE S，DUNNE D，et al．Gastric electrical stimulation with the Enterra system：a systematic review［J］．Gastroenterol Res Pract，2015：762972．DOI：10.1155/2015/762972.
［47］SHLOMOVITZ E，PESCARUS R，CASSERA M A，et al．Early human experience with per-oral endoscopic pyloromyotomy（POP）［J］．Surg Endosc，2015，29（3）：543-551．DOI：10.1007/s00464-014-3720-6.
［48］CHAVES D M，DE MOURA E G H，MESTIERI L H M，et al．Endoscopic pyloromyotomy via a gastric submucosal tunnel dissection for the treatment of gastroparesis after surgical vagal lesion［J］．Gastrointest Endosc，2014，80（1）：164．DOI：10.1016/j.gie.2014.03.045.
［49］KHASHAB M A，NGAMRUENGPHONG S，CARR-LOCKE D，et al．Gastric per-oral endoscopic myotomy for refractory gastroparesis：results from the first multicenter study on endoscopic pyloromyotomy（with video）［J］．Gastrointest Endosc，2017，85（1）：123-128．DOI：10.1016/j.gie.2016.06.048.
［50］MEKAROONKAMOL P，DACHA S，PATEL V，et al．Outcomes of per oral endoscopic pyloromyotomy in the United States［J］．Gastrointest Endosc Clin N Am，2019，29（1）：151-160．DOI：10.1016/j.giec.2018.08.009.
［51］GONZALEZ J M，BENEZECH A，VITTON V，et al．G-POEM with antro-pyloromyotomy for the treatment of refractory gastroparesis：mid-term follow-up and factors predicting outcome［J］．Aliment Pharmacol Ther，2017，46（3）：364-370．DOI：10.1111/apt.14132.
［52］ABDELFATAH M M，LI B，KAPIL N，et al．Short-term outcomes of double pyloromyotomy versus single pyloromyotomy at peroral endoscopic pyloromyotomy in treatment of gastroparesis［J］．Gastrointest Endosc，2020，92（3）：603-609．DOI：10.1016/j.gie.2020.01.016.
［53］SHEN S，LUO H，VACHAPARAMBIL C，et al．Gastric peroral endoscopic pyloromyotomy versus gastric electrical stimulation in the treatment of refractory gastroparesis：a propensity score-matched analysis of long term outcomes［J］．Endoscopy，2020，52（5）：349-358．DOI：10.1055/a-1111-8566.
［54］GONZALEZ J M，LESTELLE V，BENEZECH A，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）［J］．Gastrointest Endosc，2017，85（1）：132-139．DOI：10.1016/j.gie.2016.07.050.
［55］RODRIGUEZ J H，HASKINS I N，STRONG A T，et al．Per oral endoscopic pyloromyotomy for refractory gastroparesis：initial results from a single institution［J］．Surg Endosc，2017，31（12）：5381-5388．DOI：10.1007/s00464-017-5619-5.
［56］TU L，GHARIBANI P，YANG Y，et al．A novel approach in spinal cord stimulation for enhancing gastric motility：a preliminary study on canines［J］．J Neurogastroenterol Motil，2020，26（1）：147-159．DOI：10.5056/jnm19101.
［57］PASRICHA P J，YATES K P，NGUYEN L，et al．Outcomes and factors associated with reduced symptoms in patients with gastroparesis［J］．Gastroenterology，2015，149（7）：1762-1774.e4．DOI：10.1053/j.gastro.2015.08.008.
［58］PARKMAN H P，YATES K，HASLER W L，et al．Clinical features of idiopathic gastroparesis vary with sex，body mass，symptom onset，delay in gastric emptying，and gastroparesis severity［J］．Gastroenterology，2011，140（1）：101-115．DOI：10.1053/j.gastro.2010.10.015.

[1]	LI Qianqian, CHEN Xunrui, ZHANG Wenying, YUAN Haihua, ZHANG Yanjie, JIANG Bin, LIU Feng. Demand and Influencing Factors for Community Health Services during Chemotherapy of Patients with Advanced Cancer [J]. Chinese General Practice, 2023, 26(33): 4173-4180.
[2]	ZHOU Yuyu, GAO Chuan, CUI Puan, WANG Yaping, HE Zhong. Influencing Factors of Shared Decision Making between Doctors and Patients in Menopausal Hormone Therapy in Patients with Menopausal Syndrome [J]. Chinese General Practice, 2023, 26(33): 4181-4186.
[3]	SU Kaiqi, LYU Zhuan, WU Mingli, LUO Meng, GAO Jing, NIE Chenchen, LIU Hao, FENG Xiaodong. Effect of Electroacupuncture on BDNF/TrkB/PI3K/Akt Pathway and Hippocampal Neuronal Protection in Rats with Learning and Memory Impairment after Ischemia Reperfusion [J]. Chinese General Practice, 2023, 26(33): 4187-4193.
[4]	WANG Xu, WEI Xu, ZHU Liguo, FENG Tianxiao, WANG Zhipeng, SHI Bin. Research Ideas of the Efficacy Mechanism and Prospect Analysis of Traditional Chinese Manipulative Therapy on Treating Spinal Degenerative Diseases with Combination of Medicine and Industry [J]. Chinese General Practice, 2023, 26(33): 4118-4124.
[5]	HONG Yuchun, WU Hua, DU Yishan, LI Shuran, SUN Wenmin, YE Mingyu, ZHANG Yongjian, LI Yang. Development of General Practice Diagnostic Terminology and Coding and Empirical Study on Its Application [J]. Chinese General Practice, 2023, 26(31): 3896-3901.
[6]	ZHANG Ming, XU Jing, SUN Zhenhua, ZHAO Wenhao, MA Yingqian, ZHANG Jianqiao, SHEN Haiping. Improvement of Nutritional Status of Elderly Patients with Severe Obstruction Esophageal Carcinoma by Image-guided Photodynamic Therapy [J]. Chinese General Practice, 2023, 26(30): 3780-3784.
[7]	YAN Ke, WEI Wanyi, DENG Wenzhao, SHEN Wenbin, LI Shuguang, DU Xingyu, ZHANG Xueyuan, YANG Jie, ZHU Shuchai. Long-term Prognosis Analysis and Influencing Factors of Concurrent Chemotherapy and Radio-therapy for Cervical and Upper Thoracic Esophageal Squamous Cell Carcinoma [J]. Chinese General Practice, 2023, 26(30): 3785-3790.
[8]	YAN Ke, WEI Wanyi, LI Shuguang, YAO Weinan, DONG Jing, WANG Xiaobin, ZHANG Xueyuan, YANG Jie, SHEN Wenbin, ZHU Shuchai. Effect of Consolidation Chemotherapy on Prognosis of StageⅡ-Ⅲ Esophageal Squamous Cell Carcinoma Patients Treated with Definitive Concurrent Chemotherapy and Radio-therapy [J]. Chinese General Practice, 2023, 26(30): 3772-3779.
[9]	PU Yu, ZHANG Jixiang, DONG Weiguo. Advances in Ferroptosis and Inflammatory Bowel Disease [J]. Chinese General Practice, 2023, 26(29): 3698-3703.
[10]	WANG Qianqian, WANG Xiaohang, ZHOU Xiaoying, QIU Shanhu, SUN Zilin. Exercise is the Foundation of Weight Loss [J]. Chinese General Practice, 2023, 26(28): 3471-3476.
[11]	CHEN Jing, ZOU Tao, ZHAO Danqing, XIAO Ziwen, WU Xianqing, Chinese Medical Association Psychosomatic Medicine Branch Perinatal Mental Disorders Collaborative Group. Expert Consensus on Screening, Diagnosis and Treatment of Perinatal Mental Disorders [J]. Chinese General Practice, 2023, 26(28): 3463-3470.
[12]	PEI Bei, CHENG Lin, XU Lingyun. Effects of Different Neoadjuvant Chemotherapy Regimens on Immune Indicators and Tumor Microenvironment in HER-2-positive Breast Cancer Patients [J]. Chinese General Practice, 2023, 26(27): 3435-3440.
[13]	SUN Xiaolei, LEI Xiaolong, LIN Jiasheng, LI Keliang, GUO Ao, ZHANG Xiaohui. Effect of High Intensity Laser Combined with Physiotherapy Scoliosis Specific Exercise Therapy on Ultrasound Morphology of Multifidus Muscles in Idiopathic Scoliosis Patients with Low Back Pain [J]. Chinese General Practice, 2023, 26(27): 3456-3462.
[14]	YAO Junjie, SHANG Qiangqiang, WANG Yufeng, LI Jiahui, LIU Chang, PANG Tingting. Wearable Inertial Sensors-based Efficacy Evaluation of Comprehensive Traditional Chinese Medicine Therapy for Lumbar Disc Herniation Due to Qi-stagnation and Blood-stasis [J]. Chinese General Practice, 2023, 26(27): 3450-3455.
[15]	LIANG Xuemei, WANG Rui, ZHAO Yuhuan, XU Tianjiao, WANG Wei, SUN Weidong. Transcranial Low-level Laser Therapy: a Novel Treatment for Depression [J]. Chinese General Practice, 2023, 26(27): 3335-3341.