Dis Mon. 2011 Feb;57(2):74-101. doi: 10.1016/j.disamonth.2010.12.007.
Gastroparesis is a chronic motility disorder of the stomach that involves delayed emptying of solids and liquids, without evidence of mechanical obstruction. Although no cause can be determined for the majority of cases, the disease often develops as a complication of abdominal surgeries or because of other underlying disorders, such as diabetes mellitus or scleroderma. The pathophysiology behind delayed gastric emptying is still not well-understood, but encompasses abnormalities at 3 levels--autonomic nervous system, smooth muscle cells, and enteric neurons. Patients will often cite nausea, vomiting, postprandial fullness, and early satiety as their most bothersome symptoms on history and physical examination. Those that present with severe disease may already have developed complications, such as the formation of bezoars or masses of undigested food. In patients suspected of gastroparesis, diagnostic evaluation requires an initial upper endoscopy to rule out mechanical causes, followed by a gastric-emptying scintigraphy for diagnosis. Other diagnostic alternatives would be wireless capsule motility, antroduodenal manometry, and breath testing. Once gastroparesis is diagnosed, dietary modifications, such as the recommendation of more frequent and more liquid-based meals, are encouraged. Promotility medications like erythromycin and antiemetics like prochlorperazine are offered for symptomatic relief. These agents may be frequently changed, as the right combination of effective medications will vary with each individual. In patients who are refractory to pharmacologic treatment, more invasive options, such as intrapyloric botulinum toxin injections, placement of a jejunostomy tube, or implantation of a gastric stimulator, are considered. Future areas of research are based on current findings from clinical studies. New medications, such as hemin therapy, are emerging because of a better understanding of the pathophysiology behind gastroparesis, and present treatment options, such as gastric electric stimulation, are evolving to be more effective. Regenerative medicine and stem cell-based therapies also hold promise for gastroparesis in the near future.
胃轻瘫是一种慢性胃部动力障碍疾病，涉及固体和液体排空延迟，但无机械梗阻证据。尽管大多数病例无法确定病因，但该疾病常作为腹部手术的并发症或其他潜在疾病（如糖尿病或硬皮病）的并发症而发生。胃排空延迟的病理生理学仍未得到充分理解，但包括自主神经系统、平滑肌细胞和肠神经元 3 个层面的异常。患者常因病史和体格检查中出现恶心、呕吐、餐后饱胀和早饱而感到不适。那些病情严重的患者可能已经出现并发症，如胃石或未消化食物团块的形成。对于疑似胃轻瘫的患者，诊断评估需要进行初步上消化道内镜检查以排除机械原因，然后进行胃排空闪烁扫描以明确诊断。其他诊断选择可能包括无线胶囊动力检查、抗十二指肠测压和呼吸测试。一旦诊断出胃轻瘫，就鼓励进行饮食调整，如推荐更频繁和更基于液体的饮食。促动力药物（如红霉素）和止吐药（如丙氯拉嗪）可用于缓解症状。这些药物可能会经常更换，因为有效的药物组合会因个体而异而有所不同。对于药物治疗无效的患者，可以考虑更具侵袭性的治疗方法，如幽门内肉毒杆菌毒素注射、空肠造口管放置或胃刺激器植入。未来的研究领域基于临床研究的现有发现。由于对胃轻瘫病理生理学的更好理解，新的药物（如血红素治疗）正在出现，而目前的治疗选择（如胃电刺激）正在朝着更有效的方向发展。再生医学和基于干细胞的疗法也有望在不久的将来为胃轻瘫提供帮助。
