Homerton University Hospital, London, UK.
Barts Health, London, UK.
Dig Dis Sci. 2020 Jun;65(6):1615-1631. doi: 10.1007/s10620-020-06287-2.
Gastroparesis is characterized by delayed gastric emptying, with symptoms such as nausea, vomiting and abdominal pain, in the absence of mechanical obstruction. In most cases, it is idiopathic although diabetes mellitus is another leading cause. The physiology of gastric emptying is a complex process which is influenced by various inputs including the central nervous system, enteric nervous system and gut hormones. Developments in our understanding of gastroparesis have now demonstrated dysfunction in these systems, thus disrupting normal gastric emptying. Once mechanical obstruction is excluded, gastric scintigraphy remains the gold standard for diagnosis although wireless motility capsule and breath testing are alternative methods for diagnosis. Treatment for gastroparesis is challenging, and widely available therapies are often limited either by their poor evidence for efficacy or concerns over their long-term safety profile. Novel prokinetic agents have shown initial promise in clinical trials, and new endoscopic techniques such as gastric per-oral endoscopic myotomy are emerging. These new treatment modalities may provide an option in refractory gastroparesis with the adage of reduced morbidity compared to surgical treatments.
胃轻瘫的特征是胃排空延迟，伴有恶心、呕吐和腹痛等症状，但不存在机械性梗阻。大多数情况下，胃轻瘫是特发性的，尽管糖尿病是另一个主要原因。胃排空的生理学是一个复杂的过程，受到包括中枢神经系统、肠神经系统和肠道激素在内的各种输入的影响。我们对胃轻瘫的理解的发展现在已经证明了这些系统的功能障碍，从而破坏了正常的胃排空。一旦排除机械性梗阻，胃闪烁扫描仍然是诊断的金标准，尽管无线动力胶囊和呼吸测试是替代诊断方法。胃轻瘫的治疗具有挑战性，广泛可用的治疗方法往往因其疗效证据不足或对其长期安全性的担忧而受到限制。新型促动力药物在临床试验中显示出初步的希望，新的内镜技术，如经口内镜胃肌切开术，正在出现。与手术治疗相比，这些新的治疗方式可能为难治性胃轻瘫提供了一种选择，其优点是发病率降低。
