Department of Internal Medicine, Division of Gastroenterology, Brotzu Hospital, Cagliari 09124, Italy.
Gastrointestinal Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa 56122, Italy.
World J Gastroenterol. 2020 May 21;26(19):2333-2348. doi: 10.3748/wjg.v26.i19.2333.
Gastroparesis (Gp) is a chronic disease characterized by a delayed gastric emptying in the absence of mechanical obstruction. Although this condition has been reported in the literature since the mid-1900s, only recently has there been renewed clinical and scientific interest in this disease, which has a potentially great impact on the quality of life. The aim of this review is to explore the pathophysiological, diagnostic and therapeutical aspects of Gp according to the most recent evidence. A comprehensive online search for Gp was carried out using MEDLINE and EMBASE. Gp is the result of neuromuscular abnormalities of the gastric motor function. There is evidence that patients with idiopathic and diabetic Gp may display a reduction in nitrergic inhibitory neurons and in interstitial cells of Cajal and/or telocytes. As regards diagnostic approach, 99-Technetium scintigraphy is currently considered to be the gold standard for Gp. Its limits are a lack of standardization and a mild risk of radiation exposure. The C13 breath testing is a valid and safe alternative method. C acid octanoic and the C Spirulina platensis recently approved by the Food and Drug Administration are the most commonly used diagnostic kits. The wireless motility capsule is a promising technique, but its use is limited by costs and scarce availability in many countries. Finally, therapeutic strategies are related to the clinical severity of Gp. In mild and moderate Gp, dietary modification and prokinetic agents are generally sufficient. Metoclopramide is the only drug approved by the Food and Drug Administration for Gp. However, other older and new prokinetics and antiemetics can be considered. As a second-line therapy, tricyclic antidepressants and cannabinoids have been proposed. In severe cases the normal nutritional approach can be compromised and artificial nutrition may be needed. In drug-unresponsive Gp patients some alternative strategies (endoscopic, electric stimulation or surgery) are available.
胃轻瘫（Gp）是一种以胃排空延迟为特征的慢性疾病，而无机械性梗阻。尽管这种情况自 20 世纪中期以来就在文献中有所报道，但直到最近，人们才对这种可能对生活质量产生重大影响的疾病重新产生了临床和科学兴趣。本综述的目的是根据最新证据探讨 Gp 的病理生理、诊断和治疗方面。使用 MEDLINE 和 EMBASE 进行了全面的在线 Gp 搜索。Gp 是胃运动功能的神经肌肉异常的结果。有证据表明，特发性和糖尿病性 Gp 患者可能表现出氮能抑制性神经元和 Cajal 间质细胞和/或 Telocytes 的减少。关于诊断方法，目前认为 99-锝闪烁扫描术是 Gp 的金标准。其局限性在于缺乏标准化和轻度辐射暴露风险。C13 呼气测试是一种有效且安全的替代方法。C 辛酸和 C 螺旋藻最近被食品和药物管理局批准，是最常用的诊断试剂盒。无线动力胶囊是一种很有前途的技术，但由于成本高和在许多国家的可用性有限，其使用受到限制。最后，治疗策略与 Gp 的临床严重程度有关。在轻度和中度 Gp 中，饮食调整和促动力药物通常就足够了。胃复安是食品和药物管理局唯一批准用于 Gp 的药物。然而，其他较旧和新的促动力药和止吐药也可以考虑。作为二线治疗，三环类抗抑郁药和大麻素已被提出。在严重的情况下，正常的营养方法可能会受到影响，可能需要人工营养。对于药物无反应的 Gp 患者，一些替代策略（内镜、电刺激或手术）可用。
