Idiopathic Gastroparesis Registry Using a Predominant-Symptom Classification

"Idiopathic gastroparesis" is a poor term to describe this very heterogeneous syndrome.
Pathophysiology may not be "idiopathic," but merely unidentifiable with conventional methods
suggested for gastroparesis. The diagnosis of "gastroparesis" suggests that delayed gastric
emptying is the underlying cause of symptoms, but this description fails to explain the
variable presentation. There are fundamental differences in pathophysiology, clinical
presentation, severity, and future prognosis among patients with idiopathic gastroparesis.
Understanding these differences is necessary in order to provide cost-effective treatment in
these patients.

We believe our clinical classification for gastroparesis is a clinical useful tool in the
management of patients with idiopathic gastroparesis to predict clinical severity, treatment
response, and future prognosis. Patients with vomiting-predominant gastroparesis will be
more likely to have an underlying cause, such as viral infection or impaired glucose
tolerance with vagal neuropathy. Their symptoms will likely be persistent. Patients with
dyspepsia-predominant gastroparesis mimic those with functional dyspepsia and are unlikely
to have complications such as weight loss, and dehydration. The necessity of enteric
feeding in these patients is also unlikely. Prokinetics may help since delayed gastric
emptying may contribute to epigastric pain or postprandial distress. Finding and treating
small intestinal bacterial overgrowth as well as suggesting lifestyle and dietary
modifications may be helpful. Patients with regurgitation-predominant gastroparesis may
benefit most by improving their delayed gastric emptying. Their gastroparesis may cause
reflux-like symptoms, especially at night.