Gastroparesis and its management.

Gastroparesis may be related to a variety of underlying disorders, but diabetes mellitus is by far the most common cause. Symptoms of gastroparesis include early satiety, postprandial bloating, nausea and vomiting. Gastric scintigraphy with 99-technetium-labeled low-fat meal is the gold standard method of diagnosing delayed gastric emptying. Dietary measures and prokinetic drugs bring symptomatic relief in most patients. Some patients with severe nausea and vomiting will require antiemetic medications. Few patients will fail medical therapy and will continue to have debilitating symptoms of gastroparesis; such patients may benefit from a venting gastrostomy or a jejunostomy placed surgically, endoscopically, or fluoroscopically. Gastric electrical stimulation is an exiting new approach in the management of gastroparesis. As the treatment of gastroparesis is far from ideal, nonconventional approaches and nonstandard medications are presented.