Idiopathic Gastroparesis

Aim: to characterize the incidence, clinical features, pathophysiological mechanisms, diagnosis and treatment of patients with idiopathic gastroparesis.

Material and methods. The search for sources was carried out in publicly available databases of peer-reviewed scientific literature RSCI, CyberLeninka, PubMed/MEDLINE, Google Scholar in 1990–2025 using the keywords  “idiopathic gastroparesis”, “symptoms”, “pathophysiology”, “diagnosis”, “treatment”, “consensus”.

Results. The Consensus of the United European Gastroenterology and European Society for Neurogastroenterology and Motility on gastroparesis (2021) and the Rome Foundation and International Neurogastroenterology and Motility Societies Consensus on idiopathic gastroparesis (2025) define idiopathic gastroparesis (gastroparesis of unknown etiology) as symptoms of nausea and vomiting, often accompanied by postprandial fullness and early satiety, associated with delayed gastric emptying in the absence of mechanical obstruction. According to expert estimates, the incidence of gastroparesis in the USA is 0.16–4 %. Among the possible pathophysiological mechanisms of idiopathic gastroparesis (dysfunction of n. vagus and smooth muscle cells, loss of interstitial cells of Cajal, nNOS, macrophages, expressing heme oxygenase-1, abnormalities of syncytium of PDGFRα⁺-cells, etc.), autonomic neuropathy with loss of enteric nerves is the most proven. In the diagnosis of idiopathic gastroparesis, 4-hour scintigraphy and 13C breath test are preferred. Consensus recommendations for the idiopathic gastroparesis treatment: nutritional support, from the spectrum of pharmacological and surgical interventions, prokinetics and antiemetics are potentially useful. However, the results of treatment often do not adequately address clinical needs.

Conclusion. Large-scale prospective studies of alternative approaches to diagnosis and to individualized methods of idiopathic gastroparesis treatment are needed.

1. Sheptulin A.A., Trukhmanov A.S., Storonova O.A., Rumyantseva D.E. European Society for Neurogastroenterology and Motility Consensus on Gastroparesis: What issues remain unresolved? Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2022;32(4):89–94. (In Russ.)]. DOI: 10.22416/1382-4376-2022-32-4-89-94

2. Soykan I., Sivri B., Sarosiek I., Kiernan B., McCallum R.W. Demography, clinical characteristics, psychological and abuse profiles, treatment, and long-term follow-up of patients with gastroparesis. Dig Dis Sci. 1998;43(11):2398–404. DOI: 10.1023/A:1026665728213

3. Jung H.K., Choung R.S., Locke G.R. 3rd, Schleck C.D., Zinsmeister A.R., Szarka L.A., et al. The incidence, prevalence, and outcomes of patients with gastroparesis in Olmsted County, Minnesota, from 1996 to 2006. Gastroenterology. 2009;136(4):1225–33. DOI: 10.1053/j.gastro.2008.12.047

4. Ye Y., Yin Y., Huh S.Y., Almansa C., Bennett D., Camilleri M. Epidemiology, etiology, and treatment of gastroparesis: Real-world evidence from a large US National Claims Database. Gastroenterology. 2022;162(1):109–21. e5. DOI: 10.1053/j.gastro.2021.09.064

5. Syed A.R., Wolfe M.M., Calles-Escandon J. Epidemiology and diagnosis of gastroparesis in the United States: A population-based study. J Clin Gastroenterol. 2020;54(1):50–4. DOI: 10.1097/MCG.0000000000001231

6. Parkman H.P., Camilleri M., Farrugia G., McCallum R.W., Bharucha A.E., Mayer E.A., et al. Gastroparesis and functional dyspepsia: Excerpts from the AGA/ANMS meeting. Neurogastroenterol Motil. 2010;22(2):113–33. DOI: 10.1111/j.1365-2982.2009.01434.x

7. Parkman H.P., Yamada G., Van Natta M.L., Yates K., Hasler W.L., Sarosiek I., et al. Ethnic, racial, and sex differences in etiology, symptoms, treatment, and symptom outcomes of patients with gastroparesis. Clin Gastroenterol Hepatol. 2019;17(8):1489–99.e8. DOI: 10.1016/j.cgh.2018.10.050

8. Wadhwa V., Mehta D., Jobanputra Y., Lopez R., Thota P.N., Sanaka M.R. Healthcare utilization and costs associated with gastroparesis. World J Gastroenterol. 2017;23(24):4428–36. DOI: 10.3748/wjg.v23.i24.4428

9. Pasricha P.J., Grover M., Yates K.P., Abell T.L., Koch K.L., McCallum R.W., et al. Progress in gastroparesis — A narrative review of the work of the Gastroparesis Clinical Research Consortium. Clin Gastroenterol Hepatol. 2022;20(12):2684–95.e3. DOI: 10.1016/j.cgh.2022.05.022

10. Parkman H.P. Idiopathic gastroparesis. Gastroenterol Clin North Am. 2015;44(1):59–68. DOI: 10.1016/j.gtc.2014.11.015

11. Schol J., Wauters L., Dickman R., Drug V., Mulak A., Serra J., et al.; ESNM Gastroparesis Consensus Group. United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis. United European Gastroenterol J. 2021;9(3):287–306. DOI: 10.1002/ueg2.12060

12. Parkman H.P., Yates K., Hasler W.L., Nguyen L., Pasricha P.J., Snape W.J., et al.; National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology. 2011;140(1):101–15. DOI: 10.1053/j.gastro.2010.10.015

13. Grigor’eva I.N., Denisova D.V., Belyaevskaya E.A., Rakhimova K.O., Mustakimova R.R., Romanova T.I. Comorbidity of obesity and dyspepsia in residents of Novosibirsk aged 35–54 years. Ateroscleroz. 2025;21(2):148–55. (In Russ.)]. DOI: 10.52727/2078-256X2025-21-2-148-155

14. Parkman H.P., Van Natta M.L., Maurer A.H., Koch K.L., Grover M., Malik Z., et al. Postprandial symptoms in patients with symptoms of gastroparesis: Roles of gastric emptying and accommodation. Am J Physiol Gastrointest Liver Physiol. 2022;323(1):G44–59. DOI: 10.1152/ajpgi.00278.2021

15. Karamanolis G., Caenepeel P., Arts J., Tack J. Determinants of symptom pattern in idiopathic severely delayed gastric emptying: Gastric emptying rate or proximal stomach dysfunction? Gut. 2007;56(1):29–36. DOI: 10.1136/gut.2005.089508

16. Grover M., Farrugia G., Lurken M.S., Bernard C.E., Faussone-Pellegrini M.S., Smyrk T.C., et al.; NIDDK Gastroparesis Clinical Research Consortium. Cellular changes in diabetic and idiopathic gastroparesis. Gastroenterology. 2011;140(5):1575–85.e8. DOI: 10.1053/j.gastro.2011.01.046

17. Nguyen L., Wilson L.A., Miriel L., Pasricha P.J., Kuo B., Hasler W.L., et al.; NIDDK Gastroparesis Clinical Research Consortium (GpCRC). Autonomic function in gastroparesis and chronic unexplained nausea and vomiting: Relationship with etiology, gastric emptying, and symptom severity. Neurogastroenterol Motil. 2020;32(8):e13810. DOI: 10.1111/nmo.13810

18. Knight L.C., Parkman H.P., Brown K.L., Miller M.A., Trate D.M., Maurer A.H., et al. Delayed gastric emptying and decreased antral contractility in normal premenopausal women compared with men. Am J Gastroenterol. 1997;92(6):968–75.

19. Aziz A.A., Shah R., Aziz M.A., Amir M., Ali I.A. Gender-related differences in the hospitalization outcomes for gastroparesis. Cureus. 2025;17(6):e86239. DOI: 10.7759/cureus.86239

20. Parkman H.P., Van Natta M., Yamada G., Grover M., McCallum R.W., Sarosiek I., et al. Body weight in patients with idiopathic gastroparesis. Neurogastroenterol Motil. 2021;33(2):e13974. DOI: 10.1111/nmo.13974

21. Abell T.L., Bernstein R.K., Cutts T., Farrugia G., Forster J., Hasler W.L., et al. Treatment of gastroparesis: A multidisciplinary clinical review. Neurogastroenterol Motil. 2006;18(4):263–83. DOI: 10.1111/j.1365-2982.2006.00760.x

22. Yevsyutina Yu.V., Lyashenko O.S., Poluektova Ye.A., Lemeshko Z.A., Sheptulin A.A., Ivashkin V.T. Features of clinical presentation, diagnostics and treatment of idiopathic gastroparesis (Review of literature and case presentation). Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2013;23(3):79–84. (In Russ.)].

23. Parkman H.P., Yates K., Hasler W.L., Nguyen L., Pasricha P.J., Snape W.J., et al.; National Institute of Diabetes and Digestive and Kidney Diseases Gastroparesis Clinical Research Consortium. Similarities and differences between diabetic and idiopathic gastroparesis. Clin Gastroenterol Hepatol. 2011;9(12):1056–64. DOI: 10.1016/j.cgh.2011.08.013

24. Cherian D., Parkman H.P. Nausea and vomiting in diabetic and idiopathic gastroparesis. Neurogastroenterol Motil. 2012;24(3):217–22. DOI: 10.1111/j.1365-2982.2011.01828.x

25. Parkman H.P., Hallinan E.K., Hasler W.L., Farrugia G., Koch K.L., Calles J., et al.; NIDDK Gastroparesis Clinical Research Consortium (GpCRC). Nausea and vomiting in gastroparesis: Similarities and differences in idiopathic and diabetic gastroparesis. Neurogastroenterol Motil. 2016;28(12):1902–14. DOI: 10.1111/nmo.12893

26. Schol J., Huang I.H., Carbone F., Fernandez L.M.B., Gourcerol G., Ho V., et al. Rome Foundation and International Neurogastroenterology and Motility Societies’ Consensus on idiopathic gastroparesis. Lancet Gastroenterol Hepatol. 2025;10(1):68–81. DOI: 10.1016/S24681253(24)00284-X

27. Zárate N., Mearin F., Wang X.Y., Hewlett B., Huizinga J.D., Malagelada J.R. Severe idiopathic gastroparesis due to neuronal and interstitial cells of Cajal degeneration: Pathological findings and management. Gut. 2003;52(7):966–70. DOI: 10.1136/gut.52.7.966

28. Battaglia E., Bassotti G., Bellone G., Dughera L., Serra A.M., Chiusa L., et al. Loss of interstitial cells of Cajal network in severe idiopathic gastroparesis. World J Gastroenterol. 2006;12(38):6172–7. DOI: 10.3748/wjg.v12.i38.6172

29. Faussone-Pellegrini M.S., Grover M., Pasricha P.J., Bernard C.E., Lurken M.S., Smyrk T.C., et al.; NIDDK Gastroparesis Clinical Research Consortium (GpCRC). Ultrastructural differences between diabetic and idiopathic gastroparesis. J Cell Mol Med. 2012;16(7):1573–81. DOI: 10.1111/j.1582-4934.2011.01451.x

30. Grover M., Bernard C.E., Pasricha P.J., Lurken M.S., Faussone-Pellegrini M.S., Smyrk T.C., et al.; NIDDK Gastroparesis Clinical Research Consortium (GpCRC). Clinical-histological associations in gastroparesis: results from the Gastroparesis Clinical Research Consortium. Neurogastroenterol Motil. 2012;24(6):531–9, e249. DOI: 10.1111/j.1365-2982.2012.01894.x

31. Grover M., Bernard C.E., Pasricha P.J., Parkman H.P., Gibbons S.J., Tonascia J., et al.; NIDDK Gastroparesis Clinical Research Consortium (GpCRC). Diabetic and idiopathic gastroparesis is associated with loss of CD206-positive macrophages in the gastric antrum. Neurogastroenterol Motil. 2017;29(6):10.1111/nmo.13018. DOI: 10.1111/nmo.13018

32. Herring B.P., Hoggatt A.M., Gupta A., Griffith S., Nakeeb A., Choi J.N., et al. Idiopathic gastroparesis is associated with specific transcriptional changes in the gastric muscularis externa. Neurogastroenterol Motil. 2018;30(4):e13230. DOI: 10.1111/nmo.13230

33. Grover M., Gibbons S.J., Nair A.A., Bernard C.E., Zubair A.S., Eisenman S.T., et al.; NIDDK Gastroparesis Clinical Research Consortium (GpCRC). Transcriptomic signatures reveal immune dysregulation in human diabetic and idiopathic gastroparesis. BMC Med Genomics. 2018;11(1):62. DOI: 10.1186/s12920-018-0379-1

34. Grover M., Dasari S., Bernard C.E., Chikkamena- halli L.L., Yates K.P., Pasricha P.J., et al. Proteomics in gastroparesis: Unique and overlapping protein signatures in diabetic and idiopathic gastroparesis. Am J Physiol Gastrointest Liver Physiol. 2019;317(5):G716–26. DOI: 10.1152/ajpgi.00115.2019

35. Tazabiyev A.N., Lapina T.L., Yuryeva Ye.Yu., Napalkova N.N., Tertychny A.S., Trukhmanov A.S., et al. Gastroparesis, hypergastrinemia and stomach polypoid lesions in 53 years patient. Russian Journal of Gastroenterology, Hepatology, Coloproctology. 2018;28(1):94–8. (In Russ.)]. DOI: 10.22416/1382-4376-2018-28-1-94-98

36. Parkman H.P., Yates K.P., Hasler W.L., Nguyan L., Pasricha P.J., Snape W.J., et al.; NIDDK Gastroparesis Clinical Research Consortium. Dietary intake and nutritional deficiencies in patients with diabetic or idiopathic gastroparesis. Gastroenterology. 2011;141(2):486–98, 498. e1–7. DOI: 10.1053/j.gastro.2011.04.045

37. Ye Y., Jiang B., Manne S., Moses P.L., Almansa C., Bennett D., et al. Epidemiology and outcomes of gastroparesis, as documented in general practice records, in the United Kingdom. Gut. 2021;70(4):644–53. DOI: 10.1136/gutjnl-2020-321277

38. Perkel M.S., Moore C., Hersh T., Davidson E.D. Metoclopramide therapy in patients with delayed gastric emptying: A randomized, double-blind study. Dig Dis Sci. 1979;24(9):662–6. DOI: 10.1007/BF01314461

39. Sarosiek I., Van Natta M. Parkman H.P., Abell T., Koch K.L., Kuo B., et al.; National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) Gastroparesis Clinical Research Consortium (GpCRC). Effect of domperidone therapy on gastroparesis symptoms: Results of a dynamic cohort study by NIDDK Gastroparesis Consortium. Clin Gastroenterol Hepatol. 2022;20(3):e452–64. DOI: 10.1016/j.cgh.2021.05.063

40. Patel P., Zaher E.A., Khataniar H., Ebrahim M.A., Loganathan P. Safety and efficacy of highly selective 5-hydroxytryptamine receptor 4 agonists for diabetic and idiopathic gastroparesis: A systematic review and meta-analysis of randomized controlled trials. Cureus. 2024;16(1):e51851. DOI: 10.7759/cureus.51851

41. Carbone F., Van den Houte K., Clevers E., Andrews C., Papathanasopoulos A., Holvoet L., et al. Prucalopride in gastroparesis: A randomized placebo-controlled crossover study. Am J Gastroenterol. 2019;114(8):1265–74. DOI: 10.14309/ajg.0000000000000304

42. Fahler J., Wall G.C., Leman B.I. Gastroparesis-associated refractory nausea treated with aprepitant. Ann Pharmacother. 2012;46(12):e38. DOI: 10.1345/aph.1R484

43. Carlin J.L., Polymeropoulos C., Camilleri M., Lembo A., Fisher M., Kupersmith C., et al. The efficacy of tradipitant in patients with diabetic and idiopathic gastroparesis in a phase 3 randomized placebo-controlled clinical trial. Clin Gastroenterol Hepatol. 2024;22(12):2506–16. DOI: 10.1016/j.cgh.2024.01.005

44. Richards R.D., Davenport K., McCallum R.W. The treatment of idiopathic and diabetic gastroparesis with acute intravenous and chronic oral erythromycin. Am J Gastroenterol. 1993;88(2):203–7.

45. Parkman H.P., Van Natta M.L., Abell T.L., McCal- lum R.W., Sarosiek I., Nguyen L., et al. Effect of nortriptyline on symptoms of idiopathic gastroparesis: The NORIG randomized clinical trial. JAMA. 2013;310(24):2640–9. DOI: 10.1001/jama.2013.282833

46. Miller L.S., Szych G.A., Kantor S.B., Bromer M.Q., Knight L.C., Maurer A.H., et al. Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle. Am J Gastroenterol. 2002;97(7):1653– 60. DOI: 10.1111/j.1572-0241.2002.05823.x

47. Arts J., Holvoet L., Caenepeel P., Bisschops R., Sifrim D., Verbeke K., et al. Clinical trial: A randomized-controlled crossover study of intrapyloric injection of botulinum toxin in gastroparesis. Aliment Pharmacol Ther. 2007;26(9):1251–8. DOI: 10.1111/j.1365-2036.2007.03467.x

48. Mohan B.P., Chandan S., Jha L.K., Khan S.R., Kotagiri R., Kassab L.L., et al. Clinical efficacy of gastric per-oral endoscopic myotomy (G-POEM) in the treatment of refractory gastroparesis and predictors of outcomes: A systematic review and meta-analysis using surgical pyloroplasty as a comparator group. Surg Endosc. 2020;34(8):3352–67. DOI: 10.1007/s00464-019-07135-9

49. Abell T.L., Van Cutsem E., Abrahamsson H., Huizinga J.D., Konturek J.W., Galmiche J.P., et al. Gastric electrical stimulation in intractable symptomatic gastroparesis. Digestion. 2002;66(4):204–12. DOI: 10.1159/000068359

50. Maranki J.L., Lytes V., Meilahn J.E., Harbison S., Friedenberg F.K., Fisher R.S., et al. Predictive factors for clinical improvement with Enterra gastric electric stimulation treatment for refractory gastroparesis. Dig Dis Sci. 2008;53(8):2072–8. DOI: 10.1007/s10620-007-0124-7

51. McCallum R.W., Sarosiek I., Parkman H.P., Snape W., Brody F., Wo J., et al. Gastric electrical stimulation with Enterra therapy improves symptoms of idiopathic gastroparesis. Neurogastroenterol Motil. 2013;25(10):815–e636. DOI: 10.1111/nmo.12185

52. Kim C.H., Nelson D.K. Venting percutaneous gastrostomy in the treatment of refractory idiopathic gastroparesis. Gastrointest Endosc. 1998;47(1):67–70. DOI: 10.1016/s0016-5107(98)70301-3

53. Bhayani N.H., Sharata A.M., Dunst C.M., Kurian A.A., Reavis K.M., Swanstrom L.L. End of the road for a dysfunctional end organ: Laparoscopic gastrectomy for refractory gastroparesis. J Gastrointest Surg. 2015;19(3):411–7. DOI: 10.1007/s11605-014-2609-y

54. Pasricha P.J., Yates K.P., Nguyen L., Clarke J., Abell T.L., Farrugia G., et al. Outcomes and factors associated with reduced symptoms in patients with gastroparesis. Gastroenterology. 2015;149(7):1762–74.e4. DOI: 10.1053/j.gastro.2015.08.008