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Sensory dysfunction in gastroparesis
Gastroparesis occurs commonly as a complication of long-standing diabetes, but the in the largest group of patients no cause can be established and these are referred to as idiopathic gastroparesis patients. While delayed gastric emptying is a defining feature of gastroparesis, gastric emptying rate is inconsistently linked with symptoms and choice of or response to therapy. Hence, there are other mechanisms contributing to the pathophysiology of gastroparesis, and amongst these, visceral hypersensitivity is an important factor. This manuscript reviews methods to assess visceral sensitivity, the concept of visceral hypersensitivity, its impact on symptom pattern and severity, and the implications for treatment.
Introduction
Gastroparesis is a syndrome characterized by upper gastrointestinal symptoms including nausea or vomiting, and delayed gastric emptying in the absence of mechanical obstruction . Gastroparesis occurs in several clinical settings, particularly as a complication of diabetes mellitus, but also as a complication of upper gastrointestinal surgery, neurological disease, collagen vascular disorders, viral infections, drugs, etc. In the majority of cases no underlying cause is found and gastroparesis is termed idiopathic .
Delayed gastric emptying is a defining feature of gastroparesis, as indicated above. However, the presence and severity of slowed gastric emptying does not determine the symptom pattern, the impact on quality of life and the response to treatment . Hence, several other pathophysiological factors have been proposed to be involved in symptom generation in gastroparesis, including gastric arrhythmia, impaired gastric accommodation, redistribution of the meal within the stomach, gastro-esophageal reflux, small bowel dysmotility and visceral hypersensitivity .
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