Idiopathic gastroparesis

Idiopathic gastroparesis is a chronic disorder characterised by delayed gastric emptying in the absence of a mechanical obstruction, the exact cause of which remains unknown. It causes disabling symptoms: nausea, vomiting, early satiety and bloating, and abdominal pain. Diabetes and surgery involving the oesophagus or stomach are common causes of gastroparesis, but 40% to 50% of cases are classified as idiopathic (with no identified cause), although they are often suspected to be post-viral in origin.

Treatment aims to improve gastric emptying, manage symptoms and nutrition, and improve the patient’s quality of life. 

The diagnosis is made by gastric emptying scintigraphy. Management begins with a consultation with a gastroenterologist to assess the severity of symptoms such as nausea, vomiting, early satiety and weight loss (GCSI clinical score), and to assess nutritional status.

• Gastroscopy, medical imaging (abdominal CT scan): to rule out a mechanical obstruction.
• Gastric emptying scintigraphy: Key examination for measuring the slowness of stomach digestion.

• Dietary and lifestyle measures: Eat smaller, more frequent meals and limit fatty foods and indigestible fibre.
• Prokinetic medicines: To stimulate stomach contractions and reduce nausea (e.g. domperidone).
• Nutritional support: Enteral nutrition (tube feeding) in cases of severe malnutrition.
• Endoscopic procedure: G-POEM (Gastric Per-Oral Endoscopic Myotomy) to relax the pyloric muscle and facilitate gastric emptying in cases of severe symptoms that do not respond to dietary measures and prokinetic medicines.

Follow-up involves several specialists as part of a multidisciplinary care pathway:

• Gastroenterologists (specialists in motility disorders).
• Nutritionists/Dietitians: To adapt the diet (a low-fibre, low-fat diet).

Patients treated and followed in paediatrics transition to the gastroenterology outpatient clinic, where the follow-up required in adulthood is provided.