Review Article Gastroparesis: Concepts, Controversies, and Challenges

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Patients with gastroparesis oen present a challenge to the treating physician. Postprandial symptoms with nausea and vomiting may not only lead to nutritional and metabolic consequences, but also cause signi�cant disruptions to social activities that oen center around food.While the de�nition of gastroparesis focuses on impaired gastric emptying, treatment options that affect gastric function are limited and oen disappointing.e female predominance, the mostly idiopathic nature of the illness with a common history of abuse, and coexisting anxiety or depression show parallels with other functional disorders of the gastrointestinal tract. ese parallels provided the rationale for some initial studies investigating alternative therapies that target the brain rather than the stomach.is emerging shi inmedical therapy comes at a timewhen clinical studies suggest that gastric electrical stimulationmay exert its effects by modulating visceral sensory processing rather than altering gastric motility. Physiologic and detailed anatomic investigations also support a more complex picture with different disease mechanisms, ranging from impaired accommodation to apparent visceral hypersensitivity or decreased interstitial cells of Ca�al to in�ammatory in�ltration of myenteric ganglia. Delayed gastric emptying remains the endophenotype de�ning gastroparesis. However, our treatment options go beyond prokinetics and may allow us to improve the quality of life of affected individuals. 1