Materiały źródłowe

• #1 Gastroparesis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551528/

  Gastroparesis is a condition of delayed gastric emptying, lasting at least 3 months in the absence of mechanical obstruction. […] Delayed or ineffective gastric emptying results from abnormalities in gastrointestinal motor function, a complex sequence of events involving the parasympathetic and sympathetic nervous systems, gastric smooth muscle cells, pacemaker cells within the stomach and intestine, and the pyloric sphincter. […] Patients with gastroparesis have alterations in mucosal immune cell infiltration and cytokine expression. […] The initial step for digesting solids is gastric expansion of the fundus and proximal stomach, followed by antral contraction. […] Decreases in antral contraction and pyloric relaxation are the primary mechanisms of gastroparesis. […] Neuromuscular control is exerted at several levels, including intrinsic and extrinsic neurons, smooth muscle cells, and interstitial cells of Cajal.

• #2 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3548121/

  Gastroparesis is a clinical disorder characterized by upper gastrointestinal symptoms related with delayed gastric emptying of solids and liquids in the absence of mechanical obstruction. […] The most important mechanisms of gastroparesis, as understood to date, are loss of expression of neuronal nitric oxide synthase and loss of the interstitial cells of Cajal. […] The pathogenesis of gastroparesis is poorly understood. […] Traditionally, autonomic neuropathy was considered to be the main mechanism of DG, because it was assumed to be a symptom related to diabetic neuropathy. […] However, some patients have gastroparesis without evidence of generalized autonomic neuropathy, although these patients may have more subtle and specific disturbances in gastric autonomic innervation. […] The most important mechanisms of gastroparesis, as understood to date, are loss of expression of neuronal nitric oxide synthase (nNOS) and loss of ICC.

• #2 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  Gastroparesis is a condition that delays gastric emptying of solids and liquids in cases where there is no mechanical obstruction. A variety of mechanisms, such as vagal nerve dysfunction, sympathetic nerve dysfunction, damage to the enteric nerve system, as well as hyperglycemia itself, impede gastrointestinal (GI) function. […] The pathogenesis of gastroparesis is poorly understood. Gastric emptying entails interaction among smooth muscle, enteric and extrinsic autonomic nerves, and the interstitial cells of Cajal (ICC). Traditionally, autonomic neuropathy was considered to be the main mechanism of DG, because it was assumed to be a symptom related to diabetic neuropathy. Vagus nerve dysfunction reduces pyloric relaxation and thereby prohibits passage of foods, which are effects similar to the consequences of subdiaphragmatic vagotomy.

• #3 Gastroparesis: pathogenesis, diagnosis and management | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2011.116

  Gastroparesis is a prevalent condition that produces symptoms of delayed gastric emptying in the absence of physical blockage. […] The most common etiologies of gastroparesis are idiopathic, diabetic, and postsurgical disease, although some cases stem from autoimmune, paraneoplastic, neurologic or other conditions. […] Histologic examination of gastric tissues from patients with severe gastroparesis reveals heterogeneous and inconsistent defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal, and increased levels of inflammatory cells. […] Histopathology reveals defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal; in addition, the loss of neurotransmitters and increased levels of inflammatory cells suggests a heterogeneous pathogenesis of disease. […] Ongoing research is providing important insights into the pathogenesis, diagnosis, treatment and outcomes of this disease.

• #3 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  Gastroparesis is a condition that delays gastric emptying of solids and liquids in cases where there is no mechanical obstruction. A variety of mechanisms, such as vagal nerve dysfunction, sympathetic nerve dysfunction, damage to the enteric nerve system, as well as hyperglycemia itself, impede gastrointestinal (GI) function. […] The pathogenesis of gastroparesis is poorly understood. Gastric emptying entails interaction among smooth muscle, enteric and extrinsic autonomic nerves, and the interstitial cells of Cajal (ICC). Traditionally, autonomic neuropathy was considered to be the main mechanism of DG, because it was assumed to be a symptom related to diabetic neuropathy. Vagus nerve dysfunction reduces pyloric relaxation and thereby prohibits passage of foods, which are effects similar to the consequences of subdiaphragmatic vagotomy.

• #4 Gastroparesis – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/gastroparesis/symptoms-causes/syc-20355787

  Gastroparesis is a condition in which the muscles in the stomach don’t move food as they should for it to be digested. […] Most often, muscles contract to send food through the digestive tract. But with gastroparesis, the stomach’s movement, called motility, slows or doesn’t work at all. This keeps the stomach from emptying well. […] It’s not always clear what leads to gastroparesis. But sometimes damage to a nerve that controls the stomach muscles can cause it. This nerve is called the vagus nerve. […] The vagus nerve helps manage what happens in the digestive tract. This includes telling the muscles in the stomach to contract and push food into the small intestine. A damaged vagus nerve can’t send signals to the stomach muscles as it should. This may cause food to stay in the stomach longer. […] Conditions such as diabetes or surgery to the stomach or small intestine can damage the vagus nerve and its branches.

• #5 What is Gastroparesis – PART 1 – Dr. Nicholas L. DePace, M.D., F.A.C.C.

  https://franklincardiovascular.com/gastroparesis-part-1/

  Gastroparesis is a syndrome where an individual has objective or laboratory documented delayed gastric emptying of food from the stomach to the small intestines in the absence of any mechanical obstruction or blockage in the Gastrointestinal (GI) tract. […] Gastroparesis is a physiologic disorder. […] The diagnosis of Gastroparesis is made based on a combination of symptoms, absence of a structural abnormality or blockage, or gastric outlet obstruction or ulceration, and objectively documented delay in gastric emptying by a gastrointestinal laboratory test. […] The two major causes are idiopathic or unknown, and diabetic with the third most common cause being Gastroparesis due to various upper GI-type surgical procedures. […] Type 1 and type 2 diabetes are known to damage the Vagus Nerve. The Vagus Nerve, the major portion of the Parasympathetic nervous system outside the brain is known to control the GI tract.

• #6 Gastroparesis for the nongastroenterologist | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/373

  Gastroparesis is a heterogeneous motility disorder characterized by nausea, vomiting, and postprandial fullness. Its diagnosis requires objective documentation of delayed gastric emptying of solid food and exclusion of mechanical obstruction. […] Regardless of the cause and despite advances in understanding of the pathogenesis (which has unresolved questions), gastroparesis poses a challenge in diagnosis and management for gastroenterologists and nongastroenterologists alike. […] In diabetic and idiopathic gastroparesis, the main alterations that lead to delayed gastric emptying and symptoms are impaired accommodation of the gastric fundus and body, antral hypomotility, impaired pyloric relaxation, and dysmotility in the small intestine. […] Fewer inhibitory neurons expressing nitric oxide synthase (nitrergic neurons) may play an important role in impaired accommodation and pyloric relaxation.

• #7 Gastroparesis for the Nongastroenterologist (Part I)

  https://consultqd.clevelandclinic.org/gastroparesis-for-the-nongastroenterologist-part-i

  Gastroparesis is a chronic motility disorder and a heterogeneous syndrome with significant variability in its symptoms, causes, severity and response to treatment. […] Regardless of the cause and despite advances in understanding of the pathogenesis (which has unresolved questions), gastroparesis poses a challenge in diagnosis and management for gastroenterologists and nongastroenterologists alike. […] In diabetic and idiopathic gastroparesis, the main alterations that lead to delayed gastric emptying and symptoms are impaired accommodation of the gastric fundus and body, antral hypomotility, impaired pyloric relaxation and dysmotility in the small intestine. […] Fewer inhibitory neurons expressing nitric oxide synthase (nitrergic neurons) may play an important role in impaired accommodation and pyloric relaxation.

• #8 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  Much recent attention has been focused on intrinsic nerves in the stomach. The most important mechanisms of gastroparesis, as understood to date, are loss of expression of neuronal nitric oxide synthase (nNOS) and loss of ICC. Inhibitory nitrergic neurons in the gastric wall secret nitric oxide (NO). NO is an important cellular signaling molecule; its various functions include relaxation of smooth muscle and, consequently, accommodation of the fundus and relaxation of pylorus. […] The molecular change of enteric nervous system effects gastric emptying delay through depletion of nNOS. […] Loss of nNOS, significantly, is related to the loss of ICC in the stomach. ICC generate a slow wave in the stomach and transmit it to smooth muscle, thereby enabling phasic contraction. Loss of ICC in fact is one of the main histological findings in DG.

• #9 Gastroparesis – Wikipedia

  https://en.wikipedia.org/wiki/Gastroparesis

  Gastroparesis is a medical disorder of ineffective neuromuscular contractions (peristalsis) of the stomach, resulting in food and liquid remaining in the stomach for a prolonged period. […] The most commonly known cause is autonomic neuropathy of the vagus nerve, which innervates the stomach. Uncontrolled diabetes mellitus is a frequent cause of this nerve damage, but trauma to the vagus nerve is also possible. […] On the molecular level, it is thought that gastroparesis can be caused by the loss of neuronal nitric oxide expression since the cells in the GI tract secrete nitric oxide. […] Pathogenesis of symptoms in diabetic gastroparesis includes: Loss of gastric neurons containing nitric oxide synthase (NOS) is responsible for defective accommodation reflex, which leads to early satiety and postprandial fullness.

• #10 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  Much recent attention has been focused on intrinsic nerves in the stomach. The most important mechanisms of gastroparesis, as understood to date, are loss of expression of neuronal nitric oxide synthase (nNOS) and loss of ICC. Inhibitory nitrergic neurons in the gastric wall secret nitric oxide (NO). NO is an important cellular signaling molecule; its various functions include relaxation of smooth muscle and, consequently, accommodation of the fundus and relaxation of pylorus. […] The molecular change of enteric nervous system effects gastric emptying delay through depletion of nNOS. […] Loss of nNOS, significantly, is related to the loss of ICC in the stomach. ICC generate a slow wave in the stomach and transmit it to smooth muscle, thereby enabling phasic contraction. Loss of ICC in fact is one of the main histological findings in DG.

• #11 Diabetic gastroparesis: a disease for which long-term therapeutic benefits are difficult to obtain | Zhou | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/97086/77938

  The vagus nerve, a component of the parasympathetic nervous system, plays a crucial role in regulating stomach excitability and inhibition. Dysfunction of the vagus nerve is associated with more severe upper gastrointestinal symptoms and delayed gastric emptying. […] Consequently, when food is ingested but gastric regulation is impaired which means vagal neuropathy, which leads to decreased pyloric relaxation, impaired sinus contraction, and impaired sinus-pyloric coordination patients may experience symptoms including early satiety, nausea, vomiting, and abdominal distension. […] The intricate interactions between smooth muscle, ICC, and the intestinal and extraintestinal nervous systems are responsible for regulating gastric emptying. […] Abnormalities in ICC and macrophages are associated with abnormal increases in gastric slow waves, delayed gastric emptying, worsening clinical symptoms, and poor symptomatic response to gastric electrical stimulation (GES).

• #12 Gastroparesis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551528/

  In gastroparesis, decreased nitrous oxide levels may contribute to increased pyloric tone. […] Increased localized inflammatory cell infiltration is notable, and one possibility is that gastric stasis is associated with macrophage and CD8 T-cell infiltration of the lamina propria, an infiltration unseen in patients with functional dyspepsia but no gastroparesis. […] Both the parasympathetic and sympathetic nervous systems regulate gastric motility. […] Idiopathic and diabetic gastroparesis are associated with antral hypomotility. […] Histopathologically, gastroparesis is associated with a reduced number of autonomic ganglia and inflammatory changes resulting in abnormal gastric myoelectric motor functions. […] Gastric biopsies of patients with idiopathic and diabetic gastroparesis show loss of Cajal cells and enteric neurons and increased inflammatory infiltrates.

• #13 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3548121/

  Loss of nNOS, significantly, is related to the loss of ICC in the stomach. […] Loss of ICC in fact is one of the main histological findings in DG. […] There have been several studies on specific molecules related to the pathogenesis of gastroparesis. […] Recent work has emphasized the potential role of immune cells in the pathophysiology of gastroparesis. […] Human studies remain insufficient, though one showed that among 14 patients with refractory gastroparesis, 5 showed an absence of ICC and 9 had an ICC/normal-cell ratio of 20%. […] The Gastroparesis Clinical Research Consortium (GPCRC) of the National Institutes of Health (NIH) has achieved several promising results regarding the pathophysiology of gastroparesis.

• #14 Gastroparesis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551528/

  Gastroparesis is a condition of delayed gastric emptying, lasting at least 3 months in the absence of mechanical obstruction. […] Delayed or ineffective gastric emptying results from abnormalities in gastrointestinal motor function, a complex sequence of events involving the parasympathetic and sympathetic nervous systems, gastric smooth muscle cells, pacemaker cells within the stomach and intestine, and the pyloric sphincter. […] Patients with gastroparesis have alterations in mucosal immune cell infiltration and cytokine expression. […] The initial step for digesting solids is gastric expansion of the fundus and proximal stomach, followed by antral contraction. […] Decreases in antral contraction and pyloric relaxation are the primary mechanisms of gastroparesis. […] Neuromuscular control is exerted at several levels, including intrinsic and extrinsic neurons, smooth muscle cells, and interstitial cells of Cajal.

• #15 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3548121/

  Loss of nNOS, significantly, is related to the loss of ICC in the stomach. […] Loss of ICC in fact is one of the main histological findings in DG. […] There have been several studies on specific molecules related to the pathogenesis of gastroparesis. […] Recent work has emphasized the potential role of immune cells in the pathophysiology of gastroparesis. […] Human studies remain insufficient, though one showed that among 14 patients with refractory gastroparesis, 5 showed an absence of ICC and 9 had an ICC/normal-cell ratio of 20%. […] The Gastroparesis Clinical Research Consortium (GPCRC) of the National Institutes of Health (NIH) has achieved several promising results regarding the pathophysiology of gastroparesis.

• #16 A Critical Review of the Current Clinical Landscape of Gastroparesis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/march-2018/a-critical-review-of-the-current-clinical-landscape-of-gastroparesis/

  Employing full-thickness gastric biopsies, a loss of interstitial cells of Cajal (ICC) was identified as a common pathologic finding associated with delayed gastric emptying in diabetic, but not idiopathic, gastroparesis. However, ICC or enteric nerve loss did not correlate with symptom severity. In contrast, clinical severity and nausea were associated with a myenteric immune infiltrate among patients with idiopathic gastroparesis. […] These studies offer hope for a future that is based on proven clinicopathologic correlations.

• #17 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  There have been several studies on specific molecules related to the pathogenesis of gastroparesis. […] Recent work has emphasized the potential role of immune cells in the pathophysiology of gastroparesis. […] Human studies remain insufficient, though one showed that among 14 patients with refractory gastroparesis, 5 showed an absence of ICC and 9 had an ICC/normal-cell ratio of 20%. […] In diabetic patients, attention also has to be paid to the association between hyperglycemia and gastric emptying. Hyperglycemia stimulates pyloric contraction and inhibits antral contraction, thereby delaying the gastric emptying. […] The Gastroparesis Clinical Research Consortium (GPCRC) of the National Institutes of Health (NIH) has achieved several promising results regarding the pathophysiology of gastroparesis. An investigation of the cellular changes in patients with DG (n = 20) and IG (n = 20), referencing full-thickness biopsy specimens, discovered that 83% of patients with gastroparesis had histological abnormalities such as loss of ICC and increase in CD45 and CD68 immunoreactivity.

• #18 Gastroparesis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551528/

  In gastroparesis, decreased nitrous oxide levels may contribute to increased pyloric tone. […] Increased localized inflammatory cell infiltration is notable, and one possibility is that gastric stasis is associated with macrophage and CD8 T-cell infiltration of the lamina propria, an infiltration unseen in patients with functional dyspepsia but no gastroparesis. […] Both the parasympathetic and sympathetic nervous systems regulate gastric motility. […] Idiopathic and diabetic gastroparesis are associated with antral hypomotility. […] Histopathologically, gastroparesis is associated with a reduced number of autonomic ganglia and inflammatory changes resulting in abnormal gastric myoelectric motor functions. […] Gastric biopsies of patients with idiopathic and diabetic gastroparesis show loss of Cajal cells and enteric neurons and increased inflammatory infiltrates.

• #19 Diabetic gastroparesis: a disease for which long-term therapeutic benefits are difficult to obtain | Zhou | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/97086/77938

  The vagus nerve, a component of the parasympathetic nervous system, plays a crucial role in regulating stomach excitability and inhibition. Dysfunction of the vagus nerve is associated with more severe upper gastrointestinal symptoms and delayed gastric emptying. […] Consequently, when food is ingested but gastric regulation is impaired which means vagal neuropathy, which leads to decreased pyloric relaxation, impaired sinus contraction, and impaired sinus-pyloric coordination patients may experience symptoms including early satiety, nausea, vomiting, and abdominal distension. […] The intricate interactions between smooth muscle, ICC, and the intestinal and extraintestinal nervous systems are responsible for regulating gastric emptying. […] Abnormalities in ICC and macrophages are associated with abnormal increases in gastric slow waves, delayed gastric emptying, worsening clinical symptoms, and poor symptomatic response to gastric electrical stimulation (GES).

• #20 Gastroparesis for the nongastroenterologist | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/373

  Immune alterations seem to play an important role in the mechanism of injury. Injury and loss of the interstitial cells of Cajal, smooth muscle cells, and fibroblast-like cells, comprising the electrical syncytium of the gut, have been associated with reduced numbers of anti-inflammatory M2 macrophages, which mediate cell repair. […] Recent findings highlight that gastrointestinal motility disorders presenting with gastroparesis symptoms can occur in patients with generalized autoimmune dysautonomia. […] It is believed that an unknown number of idiopathic gastroparesis cases may fall within this category, leading to consideration of immunotherapy as a treatment option. […] However, stronger evidence regarding the immune profiles and response to immunotherapy of this group of patients is needed.

• #21 From the physiology of gastric emptying to the understanding of gastroparesis

  http://www.scielo.org.co/scielo.php?pid=S0120-99572010000200015&script=sci_arttext&tlng=en

  From the physiology of gastric emptying to the understanding of gastroparesis […] GM, and therefore gastric emptying, can be altered at different levels and by diverse causes. They result in clinical and paraclinical alterations that have been grouped together as the clinical syndrome called gastroparesis. […] Gastroparesis is a chronic alteration of gastric motility in which a delay of evacuation occurs when there is no mechanical obstruction. It is characterized by disorganization of antral peristalsis. Antral peristalsis, electrophysiology and neural transmission are important components of the emptying of solids. […] The etiology of gastroparesis includes any alteration that induces neuromuscular dysfunction of the gastrointestinal tract since gastric emptying reflects the coordination of different regions of the stomach and duodenum as well as the extrinsic modulation of the central nervous system. This includes fundic relaxation for food accommodation, antral contractions, pyloric relaxation and the coordination of the antrum, pylorus and duodenum. […] Gastric emptying results from interactions among forces that facilitate the movement of the food through the stomach (e.g. fundus tone, antral peristalsis, coordination of the antrum, pylorus and duodenum) and mechanisms that resist exit (e.g. pyloric and small intestine motility patterns). A disorganization of antral contractions has been observed in idiopathic as well as diabetic gastroparesis. […] The functions of stomach motility require the interaction of the neuronal, humoral and mechanical inhibition and stimulation processes. These are controlled by the vagus nerve and the myenteric plexus. An inhibiting mechanism that apparently plays an important role in delaying gastric emptying is stimulation of the dopamine receiver. […] It has been observed that diabetic patients have an absence of phase 3 contractions and an interrupted migratory motor complex. This has led to consideration of hypotheses such alterations of liberation or bonding with motilin. […] In idiopathic gastroparesis we have described associations with postviral neuropathy, subclinical autonomic dysfunction, alterations of the electrical rhythm, sensitivity of the smooth gastric muscle and/or the enteric nervous system to estrogens and progesterone, diminution of the function of the enteric nervous system (congenital or acquired), and psychogenic. […] It has been postulated that Prostaglandin E2 (PGE2) could be important in the physiopathology of gastroparesis. It is known that PGE2 is mostly synthesized in the gastric antrum and can affect the amount of slow waves from the migratory motor complex in certain circumstances.

• #22 Gastroparesis for the nongastroenterologist | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/373

  Gastroparesis is a heterogeneous motility disorder characterized by nausea, vomiting, and postprandial fullness. Its diagnosis requires objective documentation of delayed gastric emptying of solid food and exclusion of mechanical obstruction. […] Regardless of the cause and despite advances in understanding of the pathogenesis (which has unresolved questions), gastroparesis poses a challenge in diagnosis and management for gastroenterologists and nongastroenterologists alike. […] In diabetic and idiopathic gastroparesis, the main alterations that lead to delayed gastric emptying and symptoms are impaired accommodation of the gastric fundus and body, antral hypomotility, impaired pyloric relaxation, and dysmotility in the small intestine. […] Fewer inhibitory neurons expressing nitric oxide synthase (nitrergic neurons) may play an important role in impaired accommodation and pyloric relaxation.

• #23 Gastroparesis for the Nongastroenterologist (Part I)

  https://consultqd.clevelandclinic.org/gastroparesis-for-the-nongastroenterologist-part-i

  Gastroparesis is a chronic motility disorder and a heterogeneous syndrome with significant variability in its symptoms, causes, severity and response to treatment. […] Regardless of the cause and despite advances in understanding of the pathogenesis (which has unresolved questions), gastroparesis poses a challenge in diagnosis and management for gastroenterologists and nongastroenterologists alike. […] In diabetic and idiopathic gastroparesis, the main alterations that lead to delayed gastric emptying and symptoms are impaired accommodation of the gastric fundus and body, antral hypomotility, impaired pyloric relaxation and dysmotility in the small intestine. […] Fewer inhibitory neurons expressing nitric oxide synthase (nitrergic neurons) may play an important role in impaired accommodation and pyloric relaxation.

• #24

  https://link.springer.com/article/10.1007/s11894-020-00803-0

  Moreover, studies have shown increased smooth muscle fibrosis and decreased enteric neurons in gastroparesis. […] Gastroparetic patients have a greater total symptom score (TSS) compared with gastroparesis-like patients. […] Gastric dysrhythmias are common in gastroparesis and manifest as tachygastrias (3.7510 cpm), bradygastrias (1.02.5 cpm), and arrhythmias. […] It is necessary to highlight that GES via Enterra therapy has not been conclusively established to improve gastric emptying. […] On a cellular level, one study disclosed that while the degree of ICC reduction did not correspond with the severity of gastroparesis, those subjects with greater ICC depletion levels displayed a lessened symptomatic response to Enterra therapy. […] One potential mechanism of Enterra therapy is via increased vagus nerve efferent autonomic function.

• #25 Gastroparesis – Wikipedia

  https://en.wikipedia.org/wiki/Gastroparesis

  Impaired electromechanical activity in the myenteric plexus is responsible for delayed gastric emptying, resulting in nausea and vomiting. […] Sensory neuropathy in the gastric wall may be responsible for epigastric pain. […] Abnormal pacemaker activity (tachybradyarrhythmia) may generate a noxious signal transmitted to the CNS to evoke nausea and vomiting.

• #26 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  There have been several studies on specific molecules related to the pathogenesis of gastroparesis. […] Recent work has emphasized the potential role of immune cells in the pathophysiology of gastroparesis. […] Human studies remain insufficient, though one showed that among 14 patients with refractory gastroparesis, 5 showed an absence of ICC and 9 had an ICC/normal-cell ratio of 20%. […] In diabetic patients, attention also has to be paid to the association between hyperglycemia and gastric emptying. Hyperglycemia stimulates pyloric contraction and inhibits antral contraction, thereby delaying the gastric emptying. […] The Gastroparesis Clinical Research Consortium (GPCRC) of the National Institutes of Health (NIH) has achieved several promising results regarding the pathophysiology of gastroparesis. An investigation of the cellular changes in patients with DG (n = 20) and IG (n = 20), referencing full-thickness biopsy specimens, discovered that 83% of patients with gastroparesis had histological abnormalities such as loss of ICC and increase in CD45 and CD68 immunoreactivity.

• #27 A New Approach to Managing Gastroparesis

  https://www.uspharmacist.com/article/new-approach-to-managing-gastroparesis

  Type 1 and type 2 diabetes are known to damage the vagus nerve. Some autoimmune diseases and virus infections (e.g., HIV) are also believed to have a negative impact on the vagus nerve. […] In certain cases, the vagus nerve stops working properly due to drinking excessive alcohol. Surgical complications could also affect the vagus nerve. […] Other factors that can increase the risk of gastroparesis include abdominal or esophageal surgery, infection (usually a virus), certain medications that slow the rate of stomach emptying (such as narcotic pain medications), nervous system diseases (such as Parkinsons disease or multiple sclerosis) and hypothyroidism. […] If diabetes is causing gastroparesis, patients must control their blood glucose levels. Acute hyperglycemia may impair gastric motor function as well as inhibit the action of prokinetic drugs, such as erythromycin.

• #28 From the physiology of gastric emptying to the understanding of gastroparesis

  http://www.scielo.org.co/scielo.php?pid=S0120-99572010000200015&script=sci_arttext&tlng=en

  From the physiology of gastric emptying to the understanding of gastroparesis […] GM, and therefore gastric emptying, can be altered at different levels and by diverse causes. They result in clinical and paraclinical alterations that have been grouped together as the clinical syndrome called gastroparesis. […] Gastroparesis is a chronic alteration of gastric motility in which a delay of evacuation occurs when there is no mechanical obstruction. It is characterized by disorganization of antral peristalsis. Antral peristalsis, electrophysiology and neural transmission are important components of the emptying of solids. […] The etiology of gastroparesis includes any alteration that induces neuromuscular dysfunction of the gastrointestinal tract since gastric emptying reflects the coordination of different regions of the stomach and duodenum as well as the extrinsic modulation of the central nervous system. This includes fundic relaxation for food accommodation, antral contractions, pyloric relaxation and the coordination of the antrum, pylorus and duodenum. […] Gastric emptying results from interactions among forces that facilitate the movement of the food through the stomach (e.g. fundus tone, antral peristalsis, coordination of the antrum, pylorus and duodenum) and mechanisms that resist exit (e.g. pyloric and small intestine motility patterns). A disorganization of antral contractions has been observed in idiopathic as well as diabetic gastroparesis. […] The functions of stomach motility require the interaction of the neuronal, humoral and mechanical inhibition and stimulation processes. These are controlled by the vagus nerve and the myenteric plexus. An inhibiting mechanism that apparently plays an important role in delaying gastric emptying is stimulation of the dopamine receiver. […] It has been observed that diabetic patients have an absence of phase 3 contractions and an interrupted migratory motor complex. This has led to consideration of hypotheses such alterations of liberation or bonding with motilin. […] In idiopathic gastroparesis we have described associations with postviral neuropathy, subclinical autonomic dysfunction, alterations of the electrical rhythm, sensitivity of the smooth gastric muscle and/or the enteric nervous system to estrogens and progesterone, diminution of the function of the enteric nervous system (congenital or acquired), and psychogenic. […] It has been postulated that Prostaglandin E2 (PGE2) could be important in the physiopathology of gastroparesis. It is known that PGE2 is mostly synthesized in the gastric antrum and can affect the amount of slow waves from the migratory motor complex in certain circumstances.

• #29 Azthena logo with the word Azthena

  https://www.news-medical.net/health/Diabetic-Gastroparesis.aspx

  This neuropathy reduces autonomic ganglia and unmyelinated nerves and leads to loss of myelinated fibers in the vagal and sympathetic nerve trunks. But the severity of neuropathy does not always correlated with the severity of the symptoms. This indicates that neuropathy alone is not the cause of gastroparesis. […] There may be a dysfunction of the enteric nervous system due to diabetes. […] There may also be an underlying dysfunction of hormonal and neurotransmitter control mechanisms. There have been studies showing alterations of release of hormones like motilin, cholecystokinin, somatostatin and glucagon.

• #30 A New Paradigm Shift in Gastroparesis Management

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=1957&vmd=Full

  Gastric motility involves three main mechanisms; (1) fundic accommodation, (2) gastric phasic contraction, and (3) antro-pyloro-duodenal coordination. […] Impairment of fundic accommodation can cause nausea from unaccommodated intragastric pressure. […] Abnormal level of neurotransmitters responsible for enteric muscle contraction such as ghrelin, motilin, and substance P can lead to pylorospasm. […] Imbalance of these gastric hormones can cause impaired fundic accommodation, pylorospasm, and gastric dysmotility leading to gastroparesis. […] All key gastric dysmotility including antroduodenal hypomotility, impaired fundic accommodation, and pylorospasm interact with one another and such dysmotility can result from multiple causes including, diabetes with microvascular complications, vagal nerve injury, viral infections, metabolic disorders, neuromuscular disorders, certain medications, certain abdominal and thoracic surgery. […] However, despite better understanding of its pathophysiology, majority of gastroparesis are still from an unknown cause.

• #31 A New Paradigm Shift in Gastroparesis Management

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=1957&vmd=Full

  The conventional pathogenesis of gastroparesis focuses on a disruption of interstitial cells of Cajal network and vagal nerve injury, especially in patients with diabetic gastroparesis and postsurgical gastroparesis, while loss of synaptic vesicles and increased proinflammatory M1 macrophage are more commonly seen in patients with idiopathic gastroparesis. […] The discovery of smooth muscle cells, interstitial cells of Cajal, PDGFR+ cells syncytium as the main gastric pacemaker unit and the neuronal-specific autoantibodies targeting gastric myenteric ganglion have shifted our understanding from the disease of dysmotility to a spectrum of neuroimmunologic dysfunction with a component of autoimmunity. […] These discoveries, not only help us better understand the pathogenesis, but also open the possibilities of targeted immunotherapy in selected refractory cases.

• #32 From the physiology of gastric emptying to the understanding of gastroparesis

  http://www.scielo.org.co/scielo.php?pid=S0120-99572010000200015&script=sci_arttext&tlng=en

  From the physiology of gastric emptying to the understanding of gastroparesis […] GM, and therefore gastric emptying, can be altered at different levels and by diverse causes. They result in clinical and paraclinical alterations that have been grouped together as the clinical syndrome called gastroparesis. […] Gastroparesis is a chronic alteration of gastric motility in which a delay of evacuation occurs when there is no mechanical obstruction. It is characterized by disorganization of antral peristalsis. Antral peristalsis, electrophysiology and neural transmission are important components of the emptying of solids. […] The etiology of gastroparesis includes any alteration that induces neuromuscular dysfunction of the gastrointestinal tract since gastric emptying reflects the coordination of different regions of the stomach and duodenum as well as the extrinsic modulation of the central nervous system. This includes fundic relaxation for food accommodation, antral contractions, pyloric relaxation and the coordination of the antrum, pylorus and duodenum. […] Gastric emptying results from interactions among forces that facilitate the movement of the food through the stomach (e.g. fundus tone, antral peristalsis, coordination of the antrum, pylorus and duodenum) and mechanisms that resist exit (e.g. pyloric and small intestine motility patterns). A disorganization of antral contractions has been observed in idiopathic as well as diabetic gastroparesis. […] The functions of stomach motility require the interaction of the neuronal, humoral and mechanical inhibition and stimulation processes. These are controlled by the vagus nerve and the myenteric plexus. An inhibiting mechanism that apparently plays an important role in delaying gastric emptying is stimulation of the dopamine receiver. […] It has been observed that diabetic patients have an absence of phase 3 contractions and an interrupted migratory motor complex. This has led to consideration of hypotheses such alterations of liberation or bonding with motilin. […] In idiopathic gastroparesis we have described associations with postviral neuropathy, subclinical autonomic dysfunction, alterations of the electrical rhythm, sensitivity of the smooth gastric muscle and/or the enteric nervous system to estrogens and progesterone, diminution of the function of the enteric nervous system (congenital or acquired), and psychogenic. […] It has been postulated that Prostaglandin E2 (PGE2) could be important in the physiopathology of gastroparesis. It is known that PGE2 is mostly synthesized in the gastric antrum and can affect the amount of slow waves from the migratory motor complex in certain circumstances.

• #33 Gastroparesis for the nongastroenterologist | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/373

  Immune alterations seem to play an important role in the mechanism of injury. Injury and loss of the interstitial cells of Cajal, smooth muscle cells, and fibroblast-like cells, comprising the electrical syncytium of the gut, have been associated with reduced numbers of anti-inflammatory M2 macrophages, which mediate cell repair. […] Recent findings highlight that gastrointestinal motility disorders presenting with gastroparesis symptoms can occur in patients with generalized autoimmune dysautonomia. […] It is believed that an unknown number of idiopathic gastroparesis cases may fall within this category, leading to consideration of immunotherapy as a treatment option. […] However, stronger evidence regarding the immune profiles and response to immunotherapy of this group of patients is needed.

• #34 A New Paradigm Shift in Gastroparesis Management

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=1957&vmd=Full

  The conventional pathogenesis of gastroparesis focuses on a disruption of interstitial cells of Cajal network and vagal nerve injury, especially in patients with diabetic gastroparesis and postsurgical gastroparesis, while loss of synaptic vesicles and increased proinflammatory M1 macrophage are more commonly seen in patients with idiopathic gastroparesis. […] The discovery of smooth muscle cells, interstitial cells of Cajal, PDGFR+ cells syncytium as the main gastric pacemaker unit and the neuronal-specific autoantibodies targeting gastric myenteric ganglion have shifted our understanding from the disease of dysmotility to a spectrum of neuroimmunologic dysfunction with a component of autoimmunity. […] These discoveries, not only help us better understand the pathogenesis, but also open the possibilities of targeted immunotherapy in selected refractory cases.

• #35 Gastroparesis: pathogenesis, diagnosis and management | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2011.116

  Gastroparesis is a prevalent condition that produces symptoms of delayed gastric emptying in the absence of physical blockage. […] The most common etiologies of gastroparesis are idiopathic, diabetic, and postsurgical disease, although some cases stem from autoimmune, paraneoplastic, neurologic or other conditions. […] Histologic examination of gastric tissues from patients with severe gastroparesis reveals heterogeneous and inconsistent defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal, and increased levels of inflammatory cells. […] Histopathology reveals defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal; in addition, the loss of neurotransmitters and increased levels of inflammatory cells suggests a heterogeneous pathogenesis of disease. […] Ongoing research is providing important insights into the pathogenesis, diagnosis, treatment and outcomes of this disease.

• #36 Gastroparesis: Pathogenesis, Diagnosis, and Management

  https://www.medscape.org/viewarticle/746363

  Gastroparesis is a prevalent condition that produces symptoms of delayed gastric emptying in the absence of physical blockage. The most common etiologies of gastroparesis are idiopathic, diabetic, and postsurgical disease, although some cases stem from autoimmune, paraneoplastic, neurologic or other conditions. […] Histologic examination of gastric tissues from patients with severe gastroparesis reveals heterogeneous and inconsistent defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal, and increased levels of inflammatory cells. […] Studies over the last 5 years have defined clinical factors and characterized histopathologic findings associated with gastroparesis suggesting a heterogeneous pathogenesis.

• #37 Diabetic gastroparesis: a disease for which long-term therapeutic benefits are difficult to obtain | Zhou | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/97086/77938

  The neural network of the ENS consists of excitatory (cholinergic) and inhibitory (nitrogenergic) motor neurons, primary afferent neurons, and interneurons. Pathological alterations in these pathways disrupt the control of motility in the gastrointestinal tract, leading to delayed emptying, impaired regulation, and disturbances in gastric rhythm. […] Impairment or absence of the nitric oxide pathway may result in pyloric spasm, preventing the pylorus from relaxing while the gastric sinus contracts, ultimately impairing gastric emptying. […] The combination of inflammation and stress on neural and cellular rhythms within the gastrointestinal tract, along with the catalytic effect of H. pylori, contributes to delayed gastric emptying.

• #38 Gastroparesis – Wikipedia

  https://en.wikipedia.org/wiki/Gastroparesis

  Gastroparesis is a medical disorder of ineffective neuromuscular contractions (peristalsis) of the stomach, resulting in food and liquid remaining in the stomach for a prolonged period. […] The most commonly known cause is autonomic neuropathy of the vagus nerve, which innervates the stomach. Uncontrolled diabetes mellitus is a frequent cause of this nerve damage, but trauma to the vagus nerve is also possible. […] On the molecular level, it is thought that gastroparesis can be caused by the loss of neuronal nitric oxide expression since the cells in the GI tract secrete nitric oxide. […] Pathogenesis of symptoms in diabetic gastroparesis includes: Loss of gastric neurons containing nitric oxide synthase (NOS) is responsible for defective accommodation reflex, which leads to early satiety and postprandial fullness.

• #39 Diabetic gastroparesis: a disease for which long-term therapeutic benefits are difficult to obtain | Zhou | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/97086/77938

  The neural network of the ENS consists of excitatory (cholinergic) and inhibitory (nitrogenergic) motor neurons, primary afferent neurons, and interneurons. Pathological alterations in these pathways disrupt the control of motility in the gastrointestinal tract, leading to delayed emptying, impaired regulation, and disturbances in gastric rhythm. […] Impairment or absence of the nitric oxide pathway may result in pyloric spasm, preventing the pylorus from relaxing while the gastric sinus contracts, ultimately impairing gastric emptying. […] The combination of inflammation and stress on neural and cellular rhythms within the gastrointestinal tract, along with the catalytic effect of H. pylori, contributes to delayed gastric emptying.

• #40 Gastroparesis – StatPearls – NCBI Bookshelf

  https://www.ncbi.nlm.nih.gov/books/NBK551528/

  In gastroparesis, decreased nitrous oxide levels may contribute to increased pyloric tone. […] Increased localized inflammatory cell infiltration is notable, and one possibility is that gastric stasis is associated with macrophage and CD8 T-cell infiltration of the lamina propria, an infiltration unseen in patients with functional dyspepsia but no gastroparesis. […] Both the parasympathetic and sympathetic nervous systems regulate gastric motility. […] Idiopathic and diabetic gastroparesis are associated with antral hypomotility. […] Histopathologically, gastroparesis is associated with a reduced number of autonomic ganglia and inflammatory changes resulting in abnormal gastric myoelectric motor functions. […] Gastric biopsies of patients with idiopathic and diabetic gastroparesis show loss of Cajal cells and enteric neurons and increased inflammatory infiltrates.

• #41 The use of wireless motility capsule in the diagnosis and monitoring of gastroparesis | Abdominal Key

  https://abdominalkey.com/the-use-of-wireless-motility-capsule-in-the-diagnosis-and-monitoring-of-gastroparesis/

  Gastroparesis is a chronic disorder characterized by delayed gastric emptying in the absence of mechanical obstruction, which results in typical symptoms of nausea, vomiting, bloating, abdominal distention, postprandial fullness, early satiation, and upper abdominal pain. […] Although the sine qua non of gastroparesis involves delayed gastric emptying, the pathophysiology of gastroparesis is heterogeneous and potentially involves several mechanisms. […] Loss of gastric neurons containing nitric oxide synthase (NOS) is responsible for defective accommodation reflex, leading to early satiety and postprandial fullness. […] Impaired electromechanical activity in the myenteric plexus is responsible for delayed gastric emptying resulting in nausea and vomiting. […] Sensory neuropathy in the gastric wall may be responsible for epigastric pain.

• #42 Diabetic gastroparesis: a disease for which long-term therapeutic benefits are difficult to obtain | Zhou | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/97086

  The vagus nerve, a component of the parasympathetic nervous system, plays a crucial role in regulating stomach excitability and inhibition. Dysfunction of the vagus nerve is associated with more severe upper gastrointestinal symptoms and delayed gastric emptying. […] The ICC network, characterized by the expression of c-Kit, generates electrical waves that depolarize the smooth muscle cell (SMC) membrane, leading to the emptying of gastric contents. […] Consequently, abnormalities in ICC and macrophages are associated with abnormal increases in gastric slow waves, delayed gastric emptying, worsening clinical symptoms, and poor symptomatic response to gastric electrical stimulation (GES). […] The neural network of the ENS consists of excitatory (cholinergic) and inhibitory (nitrogenergic) motor neurons, primary afferent neurons, and interneurons.

• #43

  https://link.springer.com/article/10.1007/s11894-020-00803-0

  Gastroparesis is characterized as a syndrome of delayed gastric emptying with associated cardinal symptoms such as early satiety, postprandial fullness, nausea, vomiting, bloating, and upper abdominal pain. […] The precise mechanism of gastroparesis underlying pathophysiology has not been clearly elucidated yet. The most frequently cited causes of gastroparesis are diabetes and idiopathic and postsurgical states. […] While there is no single established mechanism of action that defines the pathophysiology of gastroparesis, much attention and research have been recently devoted to the role of interstitial cells of Cajal (ICC) in the diseases etiology. […] Gastric electrical rhythms (slow waves) are generated by ICCs and propagate around and down the stomach toward the antrum. […] In gastroparesis, there is depletion of ICCs throughout the stomach, more prominently in the pylorus.

• #44

  https://link.springer.com/article/10.1007/s11894-020-00803-0

  Moreover, studies have shown increased smooth muscle fibrosis and decreased enteric neurons in gastroparesis. […] Gastroparetic patients have a greater total symptom score (TSS) compared with gastroparesis-like patients. […] Gastric dysrhythmias are common in gastroparesis and manifest as tachygastrias (3.7510 cpm), bradygastrias (1.02.5 cpm), and arrhythmias. […] It is necessary to highlight that GES via Enterra therapy has not been conclusively established to improve gastric emptying. […] On a cellular level, one study disclosed that while the degree of ICC reduction did not correspond with the severity of gastroparesis, those subjects with greater ICC depletion levels displayed a lessened symptomatic response to Enterra therapy. […] One potential mechanism of Enterra therapy is via increased vagus nerve efferent autonomic function.

• #45 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  There have been several studies on specific molecules related to the pathogenesis of gastroparesis. […] Recent work has emphasized the potential role of immune cells in the pathophysiology of gastroparesis. […] Human studies remain insufficient, though one showed that among 14 patients with refractory gastroparesis, 5 showed an absence of ICC and 9 had an ICC/normal-cell ratio of 20%. […] In diabetic patients, attention also has to be paid to the association between hyperglycemia and gastric emptying. Hyperglycemia stimulates pyloric contraction and inhibits antral contraction, thereby delaying the gastric emptying. […] The Gastroparesis Clinical Research Consortium (GPCRC) of the National Institutes of Health (NIH) has achieved several promising results regarding the pathophysiology of gastroparesis. An investigation of the cellular changes in patients with DG (n = 20) and IG (n = 20), referencing full-thickness biopsy specimens, discovered that 83% of patients with gastroparesis had histological abnormalities such as loss of ICC and increase in CD45 and CD68 immunoreactivity.

• #46

  https://link.springer.com/article/10.1007/s11894-020-00803-0

  Moreover, studies have shown increased smooth muscle fibrosis and decreased enteric neurons in gastroparesis. […] Gastroparetic patients have a greater total symptom score (TSS) compared with gastroparesis-like patients. […] Gastric dysrhythmias are common in gastroparesis and manifest as tachygastrias (3.7510 cpm), bradygastrias (1.02.5 cpm), and arrhythmias. […] It is necessary to highlight that GES via Enterra therapy has not been conclusively established to improve gastric emptying. […] On a cellular level, one study disclosed that while the degree of ICC reduction did not correspond with the severity of gastroparesis, those subjects with greater ICC depletion levels displayed a lessened symptomatic response to Enterra therapy. […] One potential mechanism of Enterra therapy is via increased vagus nerve efferent autonomic function.

• #47

  https://www.ait-journal.com/Gastroparesis-in-the-intensive-care-unit,142975,0,2.html

  Gastroparesis is a common problem in the intensive care unit. Impaired gastric motility in critically ill patients is associated with an increased risk of enteral feeding intolerance, gastric bacterial colonization, pulmonary aspiration and progressive malnutrition leading to adverse outcomes. […] The pathomechanism of gastroparesis is complex. Disorders of gastric emptying may result from impaired relaxation of the gastric fundus in response to the food bolus, disorders of the contractile function of the body and antrum caused by atrophy of the stimulogenic (triggering) cells and the smooth muscular layer of the gastric wall, disorders of neuromuscular coordination or spastic pylorospasm (in some patients). […] Histological abnormalities of the gastric wall are found in most patients with gastroparesis and include a decrease in the number of interstitial Cajal cells, atrophy of the nerve ganglia, inflammatory infiltrations of macrophages and lymphocytes, an increase of the fibrous connective tissue. Moreover, the ratio of pro-inflammatory (M1) and anti-inflammatory (M2) macrophages has been found to be altered in gastroparesis. […] Loss of vagus nerve tone in diabetic neuropathy or following iatrogenic intraoperative damage and relative predominance of the sympathetic system impair the migrating motor complex, both directly and due to impaired release of motilin.

• #48 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3548121/

  Loss of nNOS, significantly, is related to the loss of ICC in the stomach. […] Loss of ICC in fact is one of the main histological findings in DG. […] There have been several studies on specific molecules related to the pathogenesis of gastroparesis. […] Recent work has emphasized the potential role of immune cells in the pathophysiology of gastroparesis. […] Human studies remain insufficient, though one showed that among 14 patients with refractory gastroparesis, 5 showed an absence of ICC and 9 had an ICC/normal-cell ratio of 20%. […] The Gastroparesis Clinical Research Consortium (GPCRC) of the National Institutes of Health (NIH) has achieved several promising results regarding the pathophysiology of gastroparesis.

• #49 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  There have been several studies on specific molecules related to the pathogenesis of gastroparesis. […] Recent work has emphasized the potential role of immune cells in the pathophysiology of gastroparesis. […] Human studies remain insufficient, though one showed that among 14 patients with refractory gastroparesis, 5 showed an absence of ICC and 9 had an ICC/normal-cell ratio of 20%. […] In diabetic patients, attention also has to be paid to the association between hyperglycemia and gastric emptying. Hyperglycemia stimulates pyloric contraction and inhibits antral contraction, thereby delaying the gastric emptying. […] The Gastroparesis Clinical Research Consortium (GPCRC) of the National Institutes of Health (NIH) has achieved several promising results regarding the pathophysiology of gastroparesis. An investigation of the cellular changes in patients with DG (n = 20) and IG (n = 20), referencing full-thickness biopsy specimens, discovered that 83% of patients with gastroparesis had histological abnormalities such as loss of ICC and increase in CD45 and CD68 immunoreactivity.

• #50 Gastroparesis for the Nongastroenterologist (Part I)

  https://consultqd.clevelandclinic.org/gastroparesis-for-the-nongastroenterologist-part-i

  Immune alterations seem to play an important role in the mechanism of injury. Injury and loss of the interstitial cells of Cajal, smooth muscle cells and fibroblast-like cells, comprising the electrical syncytium of the gut, have been associated with reduced numbers of anti-inflammatory M2 macrophages, which mediate cell repair.

• #51 Gastroparesis for the nongastroenterologist | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/373

  Immune alterations seem to play an important role in the mechanism of injury. Injury and loss of the interstitial cells of Cajal, smooth muscle cells, and fibroblast-like cells, comprising the electrical syncytium of the gut, have been associated with reduced numbers of anti-inflammatory M2 macrophages, which mediate cell repair. […] Recent findings highlight that gastrointestinal motility disorders presenting with gastroparesis symptoms can occur in patients with generalized autoimmune dysautonomia. […] It is believed that an unknown number of idiopathic gastroparesis cases may fall within this category, leading to consideration of immunotherapy as a treatment option. […] However, stronger evidence regarding the immune profiles and response to immunotherapy of this group of patients is needed.

• #52 Gastroparesis: pathogenesis, diagnosis and management | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/nrgastro.2011.116

  Gastroparesis is a prevalent condition that produces symptoms of delayed gastric emptying in the absence of physical blockage. […] The most common etiologies of gastroparesis are idiopathic, diabetic, and postsurgical disease, although some cases stem from autoimmune, paraneoplastic, neurologic or other conditions. […] Histologic examination of gastric tissues from patients with severe gastroparesis reveals heterogeneous and inconsistent defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal, and increased levels of inflammatory cells. […] Histopathology reveals defects in the morphology of enteric neurons, smooth muscle and interstitial cells of Cajal; in addition, the loss of neurotransmitters and increased levels of inflammatory cells suggests a heterogeneous pathogenesis of disease. […] Ongoing research is providing important insights into the pathogenesis, diagnosis, treatment and outcomes of this disease.

• #53 Gastroparesis: Etiology, clinical manifestations, and diagnosis – UpToDate

  https://www.uptodate.com/contents/gastroparesis-etiology-clinical-manifestations-and-diagnosis

  Normal gastrointestinal motor function is a complex series of events that requires coordination of the sympathetic and parasympathetic nervous systems, neurons and pacemaker cells (called interstitial cells of Cajal) within the stomach and intestine, and the smooth muscle cells of the gut. Abnormalities of this process can lead to a delay in gastric emptying (gastric stasis) […] The pathogenesis and treatment of gastroparesis are discussed separately. […] Although multiple conditions have been associated with gastroparesis, the majority of cases are idiopathic, diabetic, iatrogenic (eg, medication-induced), or postsurgical.

• #54 Diabetic gastroparesis: a disease for which long-term therapeutic benefits are difficult to obtain | Zhou | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/97086

  The pathophysiology of diabetic gastroparesis (DGP), a common complication in diabetic patients, is not fully known. Its development has been linked to several causes, including hyperglycaemia, vagal nerve dysfunction, aberrant Cajals interstitial cell network (ICC), lack of nerve nitric oxide synthase (nNOS) expression in the intermuscular plexus, and hormonal alterations in the gastrointestinal tract. […] The pathogenesis of DGP is complex. Currently, both domestic and foreign treatments primarily aim to alleviate the clinical symptoms. However, there are not enough focused and efficient therapy approaches. […] Hyperglycaemia, vagal nerve dysfunction, abnormalities in the Cajal interstitial cell network, deletion of nerve nitric oxide synthase (nNOS) expression in the intermuscular plexus, and gastrointestinal hormonal changes promote the development of DGP.

• #55 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3548121/

  Gastroparesis is a clinical disorder characterized by upper gastrointestinal symptoms related with delayed gastric emptying of solids and liquids in the absence of mechanical obstruction. […] The most important mechanisms of gastroparesis, as understood to date, are loss of expression of neuronal nitric oxide synthase and loss of the interstitial cells of Cajal. […] The pathogenesis of gastroparesis is poorly understood. […] Traditionally, autonomic neuropathy was considered to be the main mechanism of DG, because it was assumed to be a symptom related to diabetic neuropathy. […] However, some patients have gastroparesis without evidence of generalized autonomic neuropathy, although these patients may have more subtle and specific disturbances in gastric autonomic innervation. […] The most important mechanisms of gastroparesis, as understood to date, are loss of expression of neuronal nitric oxide synthase (nNOS) and loss of ICC.

• #56 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  Gastroparesis is a condition that delays gastric emptying of solids and liquids in cases where there is no mechanical obstruction. A variety of mechanisms, such as vagal nerve dysfunction, sympathetic nerve dysfunction, damage to the enteric nerve system, as well as hyperglycemia itself, impede gastrointestinal (GI) function. […] The pathogenesis of gastroparesis is poorly understood. Gastric emptying entails interaction among smooth muscle, enteric and extrinsic autonomic nerves, and the interstitial cells of Cajal (ICC). Traditionally, autonomic neuropathy was considered to be the main mechanism of DG, because it was assumed to be a symptom related to diabetic neuropathy. Vagus nerve dysfunction reduces pyloric relaxation and thereby prohibits passage of foods, which are effects similar to the consequences of subdiaphragmatic vagotomy.

• #57 Recent Advances in the Pathophysiology and Treatment of Gastroparesis

  https://www.jnmjournal.org/journal/view.html?doi=10.5056/jnm.2013.19.1.18

  There have been several studies on specific molecules related to the pathogenesis of gastroparesis. […] Recent work has emphasized the potential role of immune cells in the pathophysiology of gastroparesis. […] Human studies remain insufficient, though one showed that among 14 patients with refractory gastroparesis, 5 showed an absence of ICC and 9 had an ICC/normal-cell ratio of 20%. […] In diabetic patients, attention also has to be paid to the association between hyperglycemia and gastric emptying. Hyperglycemia stimulates pyloric contraction and inhibits antral contraction, thereby delaying the gastric emptying. […] The Gastroparesis Clinical Research Consortium (GPCRC) of the National Institutes of Health (NIH) has achieved several promising results regarding the pathophysiology of gastroparesis. An investigation of the cellular changes in patients with DG (n = 20) and IG (n = 20), referencing full-thickness biopsy specimens, discovered that 83% of patients with gastroparesis had histological abnormalities such as loss of ICC and increase in CD45 and CD68 immunoreactivity.

• #58 Diabetic gastroparesis: a disease for which long-term therapeutic benefits are difficult to obtain | Zhou | Endokrynologia Polska

  https://journals.viamedica.pl/endokrynologia_polska/article/view/97086

  Pathological alterations in these pathways disrupt the control of motility in the gastrointestinal tract, leading to delayed emptying, impaired regulation, and disturbances in gastric rhythm. […] The enteric nervous system (ENS) serves as the autonomic nervous system within the gastrointestinal tract wall and plays a crucial role in maintaining normal intestinal function, including motility and secretion. […] The absence of the nitric oxide pathway may result in pyloric spasm, preventing the pylorus from relaxing while the gastric sinus contracts, ultimately impairing gastric emptying. […] Therefore, achieving optimal blood glucose control is crucial to reducing acute symptoms and improving gastric emptying in DGP patients.

• #59 Understanding the Etiology and Spectrum of Idiopathic Gastroparesis – Practical Gastro

  https://practicalgastro.com/2017/04/01/understanding-the-etiology-and-spectrum-of-idiopathic-gastroparesis/

  Gastroparesis is a debilitating disease of delayed gastric emptying (GE) which affects approximately 10 million people in the United States. […] Although the pathophysiology of IG remains elusive. Vagal nerve impairment, changes in enteric neurons, and depletion of interstitial cells of Cajal have been demonstrated. […] Although the pathophysiology of idiopathic gastroparesis remains unclear, some mechanisms and explanations are evolving. Vagal function and regulation have been shown to be impaired among patients with DG, however, to a lesser extent in IG. […] Loss of interstitial cells of Cajal (ICC) has been a predominant finding among patients with both DG and IG, being present in up to 50% of cases and has been correlated with delayed gastric emptying in DG. […] In patients with IG, clinical severity and nausea has been associated with immune-mediated infiltration of the myenteric plexus.

• #60 Understanding the Etiology and Spectrum of Idiopathic Gastroparesis – Practical Gastro

  https://practicalgastro.com/2017/04/01/understanding-the-etiology-and-spectrum-of-idiopathic-gastroparesis/

  Gastroparesis is a debilitating disease of delayed gastric emptying (GE) which affects approximately 10 million people in the United States. […] Although the pathophysiology of IG remains elusive. Vagal nerve impairment, changes in enteric neurons, and depletion of interstitial cells of Cajal have been demonstrated. […] Although the pathophysiology of idiopathic gastroparesis remains unclear, some mechanisms and explanations are evolving. Vagal function and regulation have been shown to be impaired among patients with DG, however, to a lesser extent in IG. […] Loss of interstitial cells of Cajal (ICC) has been a predominant finding among patients with both DG and IG, being present in up to 50% of cases and has been correlated with delayed gastric emptying in DG. […] In patients with IG, clinical severity and nausea has been associated with immune-mediated infiltration of the myenteric plexus.

• #61 A Critical Review of the Current Clinical Landscape of Gastroparesis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/march-2018/a-critical-review-of-the-current-clinical-landscape-of-gastroparesis/

  Employing full-thickness gastric biopsies, a loss of interstitial cells of Cajal (ICC) was identified as a common pathologic finding associated with delayed gastric emptying in diabetic, but not idiopathic, gastroparesis. However, ICC or enteric nerve loss did not correlate with symptom severity. In contrast, clinical severity and nausea were associated with a myenteric immune infiltrate among patients with idiopathic gastroparesis. […] These studies offer hope for a future that is based on proven clinicopathologic correlations.

• #62 Gastroparesis – Gastric Diseases – Gastrointestinal Diseases – Gastroenterology – Diseases – McMaster Textbook of Internal Medicine

  https://empendium.com/mcmtextbook/chapter/B31.II.4.70.3.

  Gastroparesis is chronic delayed gastric emptying with no evidence of mechanical obstruction, resulting in food stasis in the stomach and gastric wall distention. […] Frequent: Idiopathic gastroparesis (in ~20% of cases gastroparesis may be caused by infections with cytomegalovirus [CMV]; Epstein-Barr virus [EBV]; or human herpesvirus 3 [HHV3], also referred to as varicella-zoster virus (VZV)]) and diabetes (gastroparesis as a clinical manifestation of diabetic autonomic neuropathy). […] Less frequent: Surgical complications after gastric or vagal surgery, drugs (eg, opioids, anticholinergic agents, glucagon-like peptide-1 [GLP-1] analogues), Parkinson disease, systemic sclerosis, systemic lupus erythematosus, paraneoplastic syndromes, amyloidosis, systemic mastocytosis, intestinal ischemia.

• #63 Understanding the Etiology and Spectrum of Idiopathic Gastroparesis – Practical Gastro

  https://practicalgastro.com/2017/04/01/understanding-the-etiology-and-spectrum-of-idiopathic-gastroparesis/

  There is also an evolving role of pyloric pathophysiology in the development of GP. […] One unifying concept is that gastroparesis has similarities to achalasia. In GP, there is impairment of the enteric neurons, ICC loss in the smooth muscle of the antrum, and an impaired relaxation/compliance of the pyloric sphincter resulting in retention of a meal. […] The proposed mechanism is believed to be due to inflammation, an immune-mediated phenomenon or an exacerbation or unmasking of an underlying dysmotility. […] The pathophysiology of post-infectious GP could be neuropathic or myopathic in origin.

• #64 Management of Gastroparesis

  https://www.uspharmacist.com/article/management-of-gastroparesis

  Gastroparesis is a chronic condition of the stomach characterized by a delay in gastric emptying with no mechanical obstruction present. […] In patients with gastroparesis, this nerve is believed to be damaged, leading to decreased signaling of stomach muscles, yielding a slowed emptying time and perhaps abnormal digestion. […] It is believed that neuropathic mechanisms are responsible for the altered gastric motor function and antral or pyloric contractility (associated with elevated levels of glucose). […] In regard to abdominal surgery, various disturbances in anatomy and physiology may result in delayed gastric emptying, as well as in changes in vagal modulation. […] Motilin receptor agonists help to produce antroduodenal contractility for the rhythmic forcing of food and drink through the GI tract.

• #65 A New Approach to Managing Gastroparesis

  https://www.uspharmacist.com/article/new-approach-to-managing-gastroparesis

  Type 1 and type 2 diabetes are known to damage the vagus nerve. Some autoimmune diseases and virus infections (e.g., HIV) are also believed to have a negative impact on the vagus nerve. […] In certain cases, the vagus nerve stops working properly due to drinking excessive alcohol. Surgical complications could also affect the vagus nerve. […] Other factors that can increase the risk of gastroparesis include abdominal or esophageal surgery, infection (usually a virus), certain medications that slow the rate of stomach emptying (such as narcotic pain medications), nervous system diseases (such as Parkinsons disease or multiple sclerosis) and hypothyroidism. […] If diabetes is causing gastroparesis, patients must control their blood glucose levels. Acute hyperglycemia may impair gastric motor function as well as inhibit the action of prokinetic drugs, such as erythromycin.

• #66 What is Gastroparesis – PART 1 – Dr. Nicholas L. DePace, M.D., F.A.C.C.

  https://franklincardiovascular.com/gastroparesis-part-1/

  Parasympathetic insufficiency, including that found in Diabetic and Cardiovascular Autonomic Neuropathy are highly associated with Gastroparesis. […] Injury to the Vagus Nerve is a very common cause, whether by virus, Bariatric or upper abdominal surgery. […] Many of the viruses that we have discussed, including HIV, can also damage the Vagus Nerve. […] The Vagus Nerve transmits impulses to the stomach and intestines to modulate motility through peristalsis. […] When the Vagus Nerve is damaged, transfer of food from the stomach to the small intestines is reduced because the muscles (peristalsis) will not operate properly. […] ANS dysfunction is usually caused by impaired neural transmission with increases in oxidative stress. […] There is documented loss of insulin-like growth factors and also direct damage to the interstitial cells of Cajal.

• #67

  https://link.springer.com/article/10.1007/s11894-020-00803-0

  Several studies have reported that GES did not decrease gastric transit in gastroparesis patients. […] The authors emphasized that post-vagotomy gastroparesis patients who underwent the two combined interventions exhibit the most significant response with regard to symptom severity, symptom frequency, and gastric emptying results.

• #68 A New Approach to Managing Gastroparesis

  https://www.uspharmacist.com/article/new-approach-to-managing-gastroparesis

  Gastroparesis is a chronic disorder that affects a significant subset of the population. Ordinarily, strong muscular contractions move food through the digestive tract. W gastroparesis, this mechanism is disrupted, and undigested food stays in the abdomen for a long time and makes a person feel nauseous with the urge to vomit. […] The pathophysiology behind gastroparesis is varied and depends on disease etiology. Vagal and/or autonomic neuropathy play an important role in the development of diabetic gastroparesis, and it is estimated to occur in up to 20% to 40% of patients with diabetes. […] Certain medications, such as some antidepressants, opioid pain relievers, and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. […] There are several risk factors that are considered to play a role in the conditions cause, such as vagus-nerve damage. The vagus nerve is the longest cranial nerve in the body and is responsible for many functions. It is especially essential for proper operation of the digestive tract. If the vagus nerve is damaged, transfer of food from the abdomen to the small intestine is reduced because the muscles will not operate properly.

• #69 A New Approach to Managing Gastroparesis

  https://www.uspharmacist.com/article/new-approach-to-managing-gastroparesis

  Type 1 and type 2 diabetes are known to damage the vagus nerve. Some autoimmune diseases and virus infections (e.g., HIV) are also believed to have a negative impact on the vagus nerve. […] In certain cases, the vagus nerve stops working properly due to drinking excessive alcohol. Surgical complications could also affect the vagus nerve. […] Other factors that can increase the risk of gastroparesis include abdominal or esophageal surgery, infection (usually a virus), certain medications that slow the rate of stomach emptying (such as narcotic pain medications), nervous system diseases (such as Parkinsons disease or multiple sclerosis) and hypothyroidism. […] If diabetes is causing gastroparesis, patients must control their blood glucose levels. Acute hyperglycemia may impair gastric motor function as well as inhibit the action of prokinetic drugs, such as erythromycin.

• #70 Gastroparesis: The Complex Interplay with Microbiota and the Role of Exogenous Infections in the Pathogenesis of the Disease

  https://www.mdpi.com/2076-2607/11/5/1122

  Gastroparesis (GP) is a disorder of gastric motility, characterized by delayed gastric emptying in the absence of mechanical obstruction. […] The etiology of GP is varied. This disorder is associated with diabetes (in about one-third of patients), post-surgical conditions (surgery involving damage of the vagus nerve, including esophagectomy), autoimmune diseases (Systemic Lupus Erythematosus and sclerodermia) and neurological conditions (Parkinson’s disease and multiple sclerosis). Moreover, certain bacterial, viral, and protozoal infections are associated with the development of GP. […] Recent research suggested that the microbiota may play a role in the development and progression of GP. In this review, we examine the current state of knowledge on the relationship between GP and gut microbiota, including treatment implications. In addition, we analyze the infections that are associated with disease onset.

• #71 Gastroparesis: The Complex Interplay with Microbiota and the Role of Exogenous Infections in the Pathogenesis of the Disease

  https://www.mdpi.com/2076-2607/11/5/1122

  The role of the microbiota in the pathogenesis of FGID was also hypothesized. Gastric bacterial overgrowth seems to be a rare situation and may be associated with short- and long-term complications; however, the link with gastroparesis has never been elucidated. […] The development of symptoms of GP and FD is associated not only with an increase in bacterial overgrowth in the duodenum (as mentioned earlier for SIBO) but also with alterations of microbial composition. […] The gastroduodenal impairment pivotal in the development of GP and FD appears to be linked to different pathophysiological alterations in gastric and duodenal functions, primarily characterized by duodenal acid exposure and bile acid output. […] The shift towards an oral-like or fecal-like microbiota composition was addressed as the potential mechanism of persistence of gastroparetic/dyspeptic symptoms in a sub-group of patients.

• #72 Gastroparesis: The Complex Interplay with Microbiota and the Role of Exogenous Infections in the Pathogenesis of the Disease

  https://www.mdpi.com/2076-2607/11/5/1122

  Despite its significant impact on patients’ quality of life, the underlying causes of GP remain unclear. However, emerging evidence suggests that microbiota dysbiosis may play a significant role in the development and progression of this condition. […] Infections, including viral, bacterial, and protozoal inflections, can also play a significant role in the development of GP. The effective treatment of infections is crucial to improving the symptoms and quality of life in individuals with GP caused by any of these factors. […] The relationship between exogenous microorganisms, microbiota, and GP is an iceberg that still hides most of its secrets. We await new evidence to update our notions of the basis of this complex interplay.

• #73 Gastroparesis: a turning point in understanding and treatment | Gut

  https://gut.bmj.com/content/68/12/2238.abstract

  Gastroparesis is defined by delayed gastric emptying (GE) and symptoms of nausea, vomiting, bloating, postprandial fullness, early satiety and abdominal pain. […] Mechanistic studies from diabetic animal models of delayed GE as well as human full-thickness biopsies have significantly advanced our understanding of this disorder. An innate immune dysregulation and injury to the interstitial cells of Cajal and other components of the enteric nervous system through paracrine and oxidative stress mediators is likely central to the pathogenesis of gastroparesis. […] This review highlights the clinical presentation, diagnosis, mechanisms and treatment advancements for gastroparesis.

• #74 A New Paradigm Shift in Gastroparesis Management

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=1957&vmd=Full

  Gastroparesis, once regarded as a rare disease, is difficult to diagnose and challenging to treat; there were many breakthrough advances in the 2010s, shifting the paradigm of the understanding of this complex entity and its management. […] Major developments in the three main aspects of the disease include the discovery of smooth muscle cells, interstitial cells of Cajal, PDGFR+ cells syncytium, rather than interstitial cells of Cajal alone, as the main gastric pacemaker unit; the development of validated point-of-care diagnostic modalities such as a wireless motility capsule, the carbon 13-labeled breath test, and impedance planimetry; and the introduction of novel minimally invasive therapeutic options such as newer pharmacologic agents and gastric peroral endoscopic pyloromyotomy. […] A wide range of gastric neuroimmunologic abnormalities are found in patients with gastroparesis.

• #75 Wireless Motility Capsule Versus Other Diagnostic Technologies for Evaluating Gastroparesis and Constipation: A Comparative Effectiveness Review | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/wireless-motility-capsule/research-protocol

  Gastroparesis is a condition in which patients experience the symptoms of delayed gastric emptying in the absence of an actual physical blockage. The etiologies of gastroparesis are most often idiopathic, diabetic, and postsurgical but can also rarely be autoimmune, paraneoplastic, and neurologic. Idiopathic gastroparesis is the most common etiology, estimated by some small studies to range between 36 and 64 percent of patients with the condition; diabetes is the primary cause of gastroparesis in 29 to 31 percent of patients. […] Documentation of gastric emptying delay guides physicians in their recommendations for nutrition, medication, and surgical therapies. Testing can also inform physicians about the length and severity of delay; thus, changes in diet can be made to accommodate better gastric emptying. […] Accurate diagnosis of gastroparesis is integral to decisions about management.

• #76 A New Paradigm Shift in Gastroparesis Management

  https://www.gutnliver.org/journal/view.html?pn=vol&uid=1957&vmd=Full

  Gastroparesis, once regarded as a rare disease, is difficult to diagnose and challenging to treat; there were many breakthrough advances in the 2010s, shifting the paradigm of the understanding of this complex entity and its management. […] Major developments in the three main aspects of the disease include the discovery of smooth muscle cells, interstitial cells of Cajal, PDGFR+ cells syncytium, rather than interstitial cells of Cajal alone, as the main gastric pacemaker unit; the development of validated point-of-care diagnostic modalities such as a wireless motility capsule, the carbon 13-labeled breath test, and impedance planimetry; and the introduction of novel minimally invasive therapeutic options such as newer pharmacologic agents and gastric peroral endoscopic pyloromyotomy. […] A wide range of gastric neuroimmunologic abnormalities are found in patients with gastroparesis.

• #77 Gastroparesis for the Nongastroenterologist (Part II)

  https://consultqd.clevelandclinic.org/gastroparesis-for-the-nongastroenterologist-part-ii

  Gastroparesis is a chronic motility disorder and a heterogeneous syndrome with significant variability in its symptoms, causes, severity and response to treatment. […] Regardless of the cause and despite advances in understanding of the pathogenesis (which has unresolved questions), gastroparesis poses a challenge in diagnosis and management for gastroenterologists and nongastroenterologists alike. […] Electrogastrography may complement the identification of pathophysiologic mechanisms in gastric function, as it reveals distinct patterns and electrical waves associated with specific motility disorders such as gastroparesis, functional dyspepsia and cyclic vomiting. However, the clinical significance of this information remains unclear, and as a result, it is not routinely requested. More research will help to clarify its role in clinical practice.

• #78 Doctors Perform Novel POP Procedure to Treat Gastroparesis – Mass General Advances in Motion

  https://advances.massgeneral.org/digestive-health/article.aspx?id=1366

  Gastroparesis is a condition that results in delayed stomach emptying. […] Mass General’s motility group utilizes a novel device to identify POP candidates who have pylorospasm as a primary mechanism for their gastroparesis. […] „We want to capture those patients who have pylorospasm as a primary mechanism for their gastroparesis,” says Dr. Krishnan. „We suspect that those are the patients who are going to respond the best to this.” […] „Really understanding why these patients get this condition is an area of substantial interest,” says Dr. Krishnan. „The fact that we can get to the pyloric muscle will perhaps provide a conduit for us to understand that a little bit better.”

• #79 Gastroparesis | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/gastroparesis

  Most published literature describes gastroparesis as delayed gastric emptying without a mechanical obstruction. […] The exact cause of gastroparesis is unknown. The stomach is not paralyzed. Instead, gastroparesis seems to be both a muscle and sensory problem (neuromuscular disorder). […] Factors that may contribute to gastrointestinal symptoms include: antral hypomotility, gastric dysrhythmia, impaired gastric fundic accommodation, antral distention, visceral hypersensitivity and psychological disturbance. […] Diabetic gastroparesis occurs when delayed gastric emptying affects individuals with diabetes. […] Diabetes is the disease most frequently identified as a link to gastroparesis. […] A diagnosis of gastroparesis is established if upper GI series and endoscopy of the stomach and duodenum are normal, and biochemical testing rules out correctable electrolyte or metabolic disorder.

• #80 Gastroparesis | Children’s Hospital of Philadelphia

  https://www.chop.edu/conditions-diseases/gastroparesis

  Although there is no cure for gastroparesis, the focus of pharmacological therapy is to improve patient lifestyle by attempting to improve gastric emptying, and targeting symptoms such as nausea, vomiting, abdominal bloating and abdominal pain. […] All of the above therapies currently have variable results which can range from minimal to modest effects on gastric emptying, which suggests that their effect on symptoms of gastroparesis may be mediated by a different mechanism.

• #81 What are prokinetic drugs and how can they help for gastroparesis? | Gastrointestinal Surgeon located in Louisville, KY | Vanguard Surgical LLC

  https://www.vanguardsurgical.net/post/what-are-prokinetic-drugs-and-how-can-they-help-for-gastroparesis

  Gastroparesis is a chronic condition that affects the stomach muscles and prevents proper stomach emptying. […] Prokinetic drugs are medications that help stimulate the movement of the stomach and intestines. […] Metoclopramide works by blocking dopamine receptors and increasing the levels of acetylcholine, which helps speed up gastric emptying. […] Domperidone acts as a peripheral dopamine antagonist, meaning it increases gastric emptying without crossing the blood-brain barrier as much as metoclopramide does. […] Erythromycin is an antibiotic that acts as a motilin receptor agonist, promoting contractions in the stomach. […] Baclofen is a muscle relaxant that can alter gastric motility by inhibiting neurotransmitter release.

• #82 A New Approach to Managing Gastroparesis

  https://www.uspharmacist.com/article/new-approach-to-managing-gastroparesis

  Metoclopramide is a dopamine 2 receptor antagonist, a 5-HT4 agonist, and a weak 5-HT3 receptor antagonist. It improves gastric emptying by enhancing gastric antral contractions and decreasing postprandial fundus relaxation. […] Erythromycin stimulates motilin receptors in the GI tract. Motilin receptors stimulate GI contractions and result in increased GI motility. This medicine also increases stomach-muscle contraction and may improve gastric emptying. […] Domperidone is a dopamine 2 antagonist and is available for use only under a special program administered by the FDA. […] Cisapride is a 5-HT4 agonist that stimulates antral and duodenal motility and accelerates gastric emptying of solids and liquids. […] Low-dose nortriptyline, a tricyclic antidepressant with low anticholinergic effects, has been demonstrated to decrease symptoms of nausea, vomiting, and abdominal pain in patients with diabetic and idiopathic gastroparesis.

• #83 Gastroparesis for the nongastroenterologist | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/6/373

  Immune alterations seem to play an important role in the mechanism of injury. Injury and loss of the interstitial cells of Cajal, smooth muscle cells, and fibroblast-like cells, comprising the electrical syncytium of the gut, have been associated with reduced numbers of anti-inflammatory M2 macrophages, which mediate cell repair. […] Recent findings highlight that gastrointestinal motility disorders presenting with gastroparesis symptoms can occur in patients with generalized autoimmune dysautonomia. […] It is believed that an unknown number of idiopathic gastroparesis cases may fall within this category, leading to consideration of immunotherapy as a treatment option. […] However, stronger evidence regarding the immune profiles and response to immunotherapy of this group of patients is needed.

• #84 Gastroparesis for the Nongastroenterologist (Part II)

  https://consultqd.clevelandclinic.org/gastroparesis-for-the-nongastroenterologist-part-ii

  A better understanding of the etiology of idiopathic gastroparesis is needed. […] A meticulous medical history and relevant workup are needed to accurately diagnose idiopathic gastroparesis. Also, autoimmune disorders associated with neuronal antibodies such as autoimmune gastrointestinal dysmotility should be suspected in patients with dysautonomic manifestations. This requires referral to a gastroenterologist trained in motility disorders. Strong evidence is needed before considering immunotherapy for patients with autoimmune gastrointestinal dysmotility.

• #85 Management of Gastroparesis

  https://www.uspharmacist.com/article/management-of-gastroparesis

  In certain patients, prokinetic agents may not provide adequate relief of symptoms. […] In cases of refractory gastroparesis, gastric electrical stimulation (GES) may be considered to reduce symptoms (especially dyspepsia and vomiting), as well as the need for nutritional supplementation. […] Surgical procedures may be necessary in certain patients.

• #86 About Enterra Therapy | Enterra Medical, Inc.

  https://www.enterramedical.com/hcp/about-enterra-therapy/

  The exact mechanism of action of GES is unknown, but the AGA clinical practice update on the potential mechanism hypothesizes that Enterra Therapy may impact the afferent (sensory) and efferent (motor) pathways between the stomach and central nervous system, the cell types found in the circular muscle (ICC-CM), and myoneural connections–allowing for the alleviation of symptoms. […] Enterra Therapy stimulates the nerves and smooth muscles of the stomach by delivering mild electrical pulses, thereby reducing nausea and vomiting symptoms associated with diabetic and idiopathic gastroparesis.

• #87 Gastroparesis: MedlinePlus Medical EncyclopediaLock

  https://medlineplus.gov/ency/article/000297.htm

  Gastroparesis is a condition that reduces the ability of the stomach to empty its contents. It does not involve a blockage (obstruction). […] The exact cause of gastroparesis is unknown. It may be caused by a disruption of nerve signals to the stomach. The condition is a common complication of diabetes. It can also follow some surgeries. […] People with diabetes should always control their blood sugar level. Better control of blood sugar level may improve symptoms of gastroparesis. […] Medicines that may help include: Cholinergic drugs, which act on acetylcholine nerve receptors; Erythromycin; Metoclopramide, a medicine that helps empty the stomach; Serotonin antagonist drugs, which act on serotonin receptors. […] Other treatments may include: Botulinum toxin (Botox) injected into the outlet of the stomach (pylorus); Electrical stimulation of the stomach; Surgical procedure that creates an opening between the stomach and small intestine to allow food to move through the digestive tract more easily (gastroenterostomy).

• #88

  https://link.springer.com/article/10.1007/s11894-020-00803-0

  Several studies have reported that GES did not decrease gastric transit in gastroparesis patients. […] The authors emphasized that post-vagotomy gastroparesis patients who underwent the two combined interventions exhibit the most significant response with regard to symptom severity, symptom frequency, and gastric emptying results.

• #89 A Critical Review of the Current Clinical Landscape of Gastroparesis – Gastroenterology & Hepatology

  https://www.gastroenterologyandhepatology.net/archives/march-2018/a-critical-review-of-the-current-clinical-landscape-of-gastroparesis/

  Gastroparesis is defined as “a chronic symptomatic disorder of the stomach characterized by delayed emptying without evidence of mechanical obstruction. Thus, 3 elements are central to the clinical diagnosis of gastroparesis: related symptoms, gastric emptying delay, and the absence of another organic explanation for the patient’s symptoms (eg, obstruction). […] How relevant is gastric emptying delay to symptom pathogenesis? […] Pain was not associated with gastric emptying rate, questioning the role of gastric motor dysfunction in its pathogenesis. […] The disparate and inconsistent findings from these studies suggest that gastric emptying alone is not the principal driver of symptoms in either FD or in most patients diagnosed with gastroparesis (however defined), and that other mechanisms may be relevant to individual patients or patient groups. For example, it has been observed that the symptom pattern in patients with idiopathic gastroparesis is determined more by proximal stomach dysfunction than by the severity of delayed emptying.

• #90 Gastroparesis: The Complex Interplay with Microbiota and the Role of Exogenous Infections in the Pathogenesis of the Disease

  https://www.mdpi.com/2076-2607/11/5/1122

  Despite its significant impact on patients’ quality of life, the underlying causes of GP remain unclear. However, emerging evidence suggests that microbiota dysbiosis may play a significant role in the development and progression of this condition. […] Infections, including viral, bacterial, and protozoal inflections, can also play a significant role in the development of GP. The effective treatment of infections is crucial to improving the symptoms and quality of life in individuals with GP caused by any of these factors. […] The relationship between exogenous microorganisms, microbiota, and GP is an iceberg that still hides most of its secrets. We await new evidence to update our notions of the basis of this complex interplay.

• #91 Gastroparesis for the Nongastroenterologist (Part II)

  https://consultqd.clevelandclinic.org/gastroparesis-for-the-nongastroenterologist-part-ii

  A better understanding of the etiology of idiopathic gastroparesis is needed. […] A meticulous medical history and relevant workup are needed to accurately diagnose idiopathic gastroparesis. Also, autoimmune disorders associated with neuronal antibodies such as autoimmune gastrointestinal dysmotility should be suspected in patients with dysautonomic manifestations. This requires referral to a gastroenterologist trained in motility disorders. Strong evidence is needed before considering immunotherapy for patients with autoimmune gastrointestinal dysmotility.

• #92 Mechanisms of Disease: the pathological basis of gastroparesis—a review of experimental and clinical studies | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/ncpgasthep0838

  The pathogenesis of gastroparesis is complicated and poorly understood. This lack of understanding remains a major impediment to the development of effective therapies for this condition. […] Most of the scientific information available on the pathogenesis of gastroparesis has been derived from experimental studies of diabetes in animals. These studies suggest that the disease process can affect nerves (particularly those producing nitric oxide, but also the vagus nerve), interstitial cells of Cajal and smooth muscle. […] The available data do, however, suggest that multiple cellular targets are involved. In practice, though, symptoms seldom correlate with objective measures of gastric function and there is still a lot to learn about the pathophysiology of gastroparesis. Future studies should focus on understanding the molecular pathways that lead to gastric dysfunction, in animal models and in humans, and pave the way for the development of rational therapies.

• #93 Mechanisms of Disease: the pathological basis of gastroparesis—a review of experimental and clinical studies | Nature Reviews Gastroenterology & Hepatology

  https://www.nature.com/articles/ncpgasthep0838

  The pathogenesis of gastroparesis is complex; disruption of gastric function occurs at multiple cellular levels. […] Evidence suggests that the pathogenesis of gastroparesis might involve nerves (particularly those producing nitric oxide, but also the vagus nerve), interstitial cells of Cajal and smooth muscle. […] Most research into the pathogenesis of gastroparesis has been performed in animals; human studies are limited. […] Further studies in animal models and humans are needed to increase our understanding of the molecular pathways that lead to gastric dysfunction so that viable treatment options can be developed.

• #94 Epidemiology, pathophysiology, and treatment options for gastroparesis

  https://lirias.kuleuven.be/4135688?limo=0

  Gastroparesis is a clinical syndrome characterized by delayed emptying of solid food from the stomach in the absence of a mechanical obstruction. […] The pathophysiology behind gastroparesis is varied and depends on disease etiology. However, the pathogenesis of gastroparesis has not been clearly established. […] Novel treatments targeted to new mechanisms are needed to explore.

Zobacz więcej