Mistakes in gastroparesis and how to avoid them

Filters:

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Mistakes in gastroparesis and how to avoid them

Asma Fikree

Summary

AI Generated

This article examines common diagnostic mistakes in gastroparesis, a condition defined by delayed gastric emptying with nausea and vomiting, which has seen a dramatic rise in US diagnoses from 21 cases in 1958 to 5 million in 2019.

Gastroparesis is defined as delayed gastric emptying associated primarily with nausea and vomiting in the absence of mechanical obstruction, first described by Kassander in 1958 as 'gastroparesis diabeticorum'
Hospital admissions for gastroparesis are rising much faster than for related conditions such as nausea and vomiting, gastro-oesophageal reflux disease, gastritis or gastric ulcers, which remain relatively static, representing a major healthcare burden
The author suggests the rapid increase in prevalence likely occurred because it has become easier to measure gastric emptying and attribute symptoms without necessarily considering differential diagnoses
Most cases are caused by diabetes (type 1 more than type 2) or surgical procedures disrupting the vagus nerve such as Billroth gastrectomy, oesophagectomy, gastric bypass surgery and fundoplication, though cases can be idiopathic
Clinicians managing patients with suspected gastroparesis would benefit from understanding the most frequent diagnostic mistakes in this condition

Download PDF

Was this helpful?

Thanks for your feedback.

This summary was generated by an AI large language model based on the content transcript. It is for informational purposes only and should not be considered a substitute for clinical judgment. Always rely on your professional expertise and the full clinical context when making clinical decisions.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48: 797–812. [Link]

Wang YR, Fisher RS and Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol 2008; 103: 313–322. [Link]

Parkman HP, Yates K, Hasler WL, et al. Clinical features of idiopathic gastroparesis vary with sex, body mass, symptom onset, delay in gastric emptying, and gastroparesis severity. Gastroenterology 2011; 140: 101–115. [Link]

Abell TL, Camilleri M, Donohoe K, et al. Consensus recommendations for gastric emptying scintigraphy: a joint report of the American Neurogastroenterology and Motility Society and the Society of Nuclear Medicine. J Nucl Med Technol 2008; 36: 44–54. [Link]

Murray HB, Jehangir A, Silvernale CJ, et al. Avoidant/restrictive food intake disorder symptoms are frequent in patients presenting for symptoms of gastroparesis. Neurogastroenterol Motil 2020; 32: e13931. [Link]

Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543. [Link]

Olausson EA, Störsrud S, Grundin H, et al. A small particle size diet reduces upper gastrointestinal symptoms in patients with diabetic gastroparesis: a randomized controlled trial. Am J Gastroenterol 2014; 109: 375–385. [Link]

Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403. [Link]

Erbas T, Varoglu E, Erbas B, et al. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993; 16: 1511–1514. [Link]

10.

Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol 2019; 114: 1265–1274. [Link]

11.

Jehangir A and Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol 2017; 23: 7310–7320. [Link]

12.

Fass R, McCallum RW and Parkman HP. Clinical Roundtable Monograph: Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol 2009: 5 (Suppl 18); 4–11. [Link]

13.

Calles-Escandón J, Koch KL, Hasler WL, et al. Glucose sensor-augmented continuous subcutaneous insulin infusion in patients with diabetic gastroparesis: an open-label pilot prospective study. PLoS One 2018; 13: e0194759. [Link]

14.

Parkman HP, Wilson LA, Hasler WL, et al. Abdominal pain in patients with gastroparesis: associations with gastroparesis symptoms, etiology of gastroparesis, gastric emptying, somatization, and quality of life. Dig Dis Sci 2019; 64: 2242–2255. [Link]

15.

Zoll B, Jehangir A, Malik Z, et al. Gastric electric stimulation for refractory gastroparesis. J Clin Outcomes Manag 2019; 26: 27–38. [Link]

Abstract

The term ‘gastroparesis’ was first coined by Kassander in 1958 to describe the fact that barium did not leave the stomach of patients with diabetes for over 24 hours — so-called ‘gastroparesis diabeticorum’. Nowadays it refers to a delay in gastric emptying that is associated with symptoms primarily of nausea and vomiting as well as the absence of mechanical obstruction. In 1958, 21 cases were described, but in 2019, 5 million US individuals were diagnosed as having gastroparesis. This rapid increase in prevalence is likely to have occurred because it has become much easier to measure gastric emptying and to attribute symptoms to this without necessarily thinking through differentials. The incidence of hospital admissions for patients labelled as having gastroparesis is rapidly rising, increasing at a much faster rate than admissions for patients with nausea and vomiting, gastro-oesophageal reflux disease, gastritis or gastric ulcers, which are all remaining relatively static. Gastroparesis therefore represents a major healthcare burden. Gastroparesis can be idiopathic or is most frequently caused by diabetes (type 1 more than type 2) or surgical procedures that can disrupt the vagus nerve (e.g. Billroth gastrectomy, oesophagectomy, gastric bypass surgery and fundoplication). In this article, I describe the mistakes most frequently made in patients who have a suspected diagnosis of gastroparesis. I base my discussion on the available evidence as well as clinical experience in the field.

Topics

Neurogastroenterology & Motility Stomach & H. Pylori

Citation

Fikree A. Mistakes in gastroparesis and how to avoid them. UEG Education 2021; 21: 18–22.

Published

2021

More Like This:

Coeliac disease with David Sanders

Pradeep Mundre

MASLD with Sven Francque - Part 2

Pradeep Mundre

Mistakes in the management of peritoneal malignancies and how to avoid them

Charlotte Rabl

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

UEG Podcast Episode

UEG Podcast

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Coeliac disease with David Sanders

David S. Sanders, Pradeep Mundre

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Topics

Small Intestine & Nutrition

Published

2026

More Like This:

Coeliac disease with David Sanders

Pradeep Mundre

MASLD with Sven Francque - Part 2

Pradeep Mundre

Mistakes in the management of peritoneal malignancies and how to avoid them

Charlotte Rabl

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

UEG Podcast Episode

UEG Podcast

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

MASLD with Sven Francque - Part 2

Sven Francque, Pradeep Mundre

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Abstract

Topics

Hepatobiliary

Published

2026

More Like This:

Coeliac disease with David Sanders

Pradeep Mundre

MASLD with Sven Francque - Part 2

Pradeep Mundre

Mistakes in the management of peritoneal malignancies and how to avoid them

Charlotte Rabl

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Mistakes in the management of peritoneal malignancies and how to avoid them

Francesco Saverio Papadia, Matteo Santoliquido, Andrea Barberis, Tarkan Jäger, Charlotte Rabl

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48: 797–812. [Link]

Wang YR, Fisher RS and Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol 2008; 103: 313–322. [Link]

Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543. [Link]

Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403. [Link]

Erbas T, Varoglu E, Erbas B, et al. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993; 16: 1511–1514. [Link]

10.

Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol 2019; 114: 1265–1274. [Link]

11.

Jehangir A and Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol 2017; 23: 7310–7320. [Link]

12.

Fass R, McCallum RW and Parkman HP. Clinical Roundtable Monograph: Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol 2009: 5 (Suppl 18); 4–11. [Link]

13.

14.

15.

Zoll B, Jehangir A, Malik Z, et al. Gastric electric stimulation for refractory gastroparesis. J Clin Outcomes Manag 2019; 26: 27–38. [Link]

Abstract

Peritoneal malignancies represent a complex and often misjudged clinical challenge. Historically synonymous with a terminal diagnosis, the advent of cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) radically altered the prognosis for selected patients. However, progress has been jeopardised by a series of recurring and preventable errors in diagnosis, staging, and treatment selection. This article delineates the ten most critical pitfalls in managing peritoneal surface malignancies. For each pitfall, we provide evidence-based explanations, concrete clinical examples, and strategic recommendations for avoidance. We emphasise the pivotal role of early multidisciplinary discussion, precise imaging, and timely referral to high-volume expert centres to optimise patient outcomes and offer curative intent where previously there was none.

Topics

Digestive Oncology Surgery

Published

2026

More Like This:

Coeliac disease with David Sanders

Pradeep Mundre

MASLD with Sven Francque - Part 2

Pradeep Mundre

Mistakes in the management of peritoneal malignancies and how to avoid them

Charlotte Rabl

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Mistakes in hepatitis C and how to avoid them

Ana Catarina Garcia, Gonçalo Alexandrino

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48: 797–812. [Link]

Wang YR, Fisher RS and Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol 2008; 103: 313–322. [Link]

Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543. [Link]

Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403. [Link]

Erbas T, Varoglu E, Erbas B, et al. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993; 16: 1511–1514. [Link]

10.

Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol 2019; 114: 1265–1274. [Link]

11.

Jehangir A and Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol 2017; 23: 7310–7320. [Link]

12.

Fass R, McCallum RW and Parkman HP. Clinical Roundtable Monograph: Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol 2009: 5 (Suppl 18); 4–11. [Link]

13.

14.

15.

Zoll B, Jehangir A, Malik Z, et al. Gastric electric stimulation for refractory gastroparesis. J Clin Outcomes Manag 2019; 26: 27–38. [Link]

Abstract

Hepatitis C virus (HCV) infection remains an important global health concern. It is estimated that there are approximately 50 million people infected with HCV globally, with around 1 million new infections each year and about 242,000 deaths annually attributed to HCV-related complications. Most acute HCV infections (55–85%) become chronic due to the virus’s effective evasion strategies, with spontaneous clearance being rare once chronicity is established. This condition often progresses silently, with many individuals unaware of their infection until advanced liver damage has occurred. If left untreated, HCV can lead to severe complications, including liver cirrhosis and hepatocellular carcinoma (HCC). HCV transmission occurs mainly through percutaneous exposure to infected blood. HCV can also spread from mother to infant (vertical transmission) and, less frequently, via sexual contact.1,2 In recent years, the introduction of oral direct-acting antivirals (DAAs), with remarkable safety and effectiveness profiles, has led to a sustained virological response (SVR) in virtually all (>97%) HCV-infected patients, regardless of HCV genotype or disease stage. However, significant barriers remain, such as issues with diagnosis, access to treatment and awareness of the disease.

Here, we discuss some of the misconceptions in HCV management and provide a practical management approach grounded in evidence and clinical experience.

Topics

Hepatobiliary

Citation

Garcia A.C and Alexandrino G. Mistakes in hepatits C and how to avoid them. UEG Education 2025; 25: 14-17.

Published

2025

More Like This:

Coeliac disease with David Sanders

Pradeep Mundre

MASLD with Sven Francque - Part 2

Pradeep Mundre

Mistakes in the management of peritoneal malignancies and how to avoid them

Charlotte Rabl

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

UEG Mistakes In Articles

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

References

Mistakes

References

Mistake 1 Mistake 2 Mistake 3 Mistake 4 Mistake 5 Mistake 6 Mistake 7 Mistake 8 Mistake 9 Mistake 10

Kassander P. Asymptomatic gastric retention in diabetics (gastroparesis diabeticorum). Ann Intern Med 1958; 48: 797–812. [Link]

Wang YR, Fisher RS and Parkman HP. Gastroparesis-related hospitalizations in the United States: trends, characteristics, and outcomes, 1995–2004. Am J Gastroenterol 2008; 103: 313–322. [Link]

Wuestenberghs F, Juge M, Melchior C, et al. Association between symptoms, quality of life, and gastric emptying in dyspeptic patients. J Neurogastroenterol Motil 2019; 25: 534–543. [Link]

Paine P, McMahon M, Farrer K, et al. Jejunal feeding: when is it the right thing to do? Frontline Gastroenterol 2019; 11: 397–403. [Link]

Erbas T, Varoglu E, Erbas B, et al. Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993; 16: 1511–1514. [Link]

10.

Carbone F, Van den Houte K, Clevers E, et al. Prucalopride in gastroparesis: a randomized placebo-controlled crossover study. Am J Gastroenterol 2019; 114: 1265–1274. [Link]

11.

Jehangir A and Parkman HP. Chronic opioids in gastroparesis: relationship with gastrointestinal symptoms, healthcare utilization and employment. World J Gastroenterol 2017; 23: 7310–7320. [Link]

12.

Fass R, McCallum RW and Parkman HP. Clinical Roundtable Monograph: Treatment challenges in the management of gastroparesis-related GERD. Gastroenterol Hepatol 2009: 5 (Suppl 18); 4–11. [Link]

13.

14.

15.

Zoll B, Jehangir A, Malik Z, et al. Gastric electric stimulation for refractory gastroparesis. J Clin Outcomes Manag 2019; 26: 27–38. [Link]

Abstract

Malnutrition frequently occurs in patients who have chronic liver disease and worsens their prognosis. There are multiple causes of malnutrition in the context of cirrhosis: low dietary intake, malabsorption, metabolic alterations and modification of substrate utilisation. Sarcopenia, which is defined by loss of muscle mass and function, is a major component of malnutrition in patients with cirrhosis. Sarcopenia adversely affects the number and severity of complications, quality of life, the outcome of liver transplantation and the overall survival rate of patients with advanced liver disease. Physicians should be aware of the clinical and prognostic relevance of nutritional status, how to promptly recognise malnutrition and sarcopenia in patients with liver cirrhosis and how to appropriately manage these conditions. Here we discuss some mistakes that are frequently made regarding nutrition in chronic liver disease, and we provide evidence and experience-based approaches to avoid them.

Topics

Hepatobiliary Small Intestine & Nutrition

Citation

Merli M and Lapenna L. Mistakes in nutrition in chronic liver disease and how to avoid them. UEG Education 2021; 21: 23–25

Published

2021

More Like This:

Coeliac disease with David Sanders

Pradeep Mundre

MASLD with Sven Francque - Part 2

Pradeep Mundre

Mistakes in the management of peritoneal malignancies and how to avoid them

Charlotte Rabl

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

UEG Standards and Guidelines

Consensus

Share via Email Share on Facebook Share on X Share on LinkedIn Share on Bluesky

This content is part of Gutflix. Log in with your myUEG account, or create one free, to watch it.

Not sure what you can access? Learn more about account types.

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada

Summary

AI Generated

Summary is not available for this content yet.

Download PDF

Was this helpful?

Thanks for your feedback.

Guideline

ABSTRACT

Introduction

Chronic nausea and vomiting are symptoms of a wide range of gastrointestinal and non-gastrointestinal conditions. Diagnosis can be challenging and requires a systematic and well-structured approach. If the initial investigation for structural, toxic and metabolic disorders is negative, digestive motility and gut-brain interaction disorders should be assessed. United European Gastroenterology (UEG) and the European Society for Neurogastroenterology and Motility (ESNM) identified the need for an updated, evidence-based clinical guideline for the management of chronic nausea and vomiting.

Methods

A multidisciplinary team of experts in the field, including European specialists and national societies, participated in the development of the guideline. Relevant questions were addressed through a literature review and statements were developed and voted on according to a Delphi process.

Results

Ninety-eight statements were identified and voted following the Delphi process. Overall agreement was high, although the grade of scientific evidence was low in many areas. Disagreement was more evident for some pharmacological treatment options. A diagnostic algorithm was developed, focussing on the differentiating features between gastrointestinal motility and gut-brain interaction disorders with predominant nausea and vomiting.

Conclusion

These guidelines provide an evidence-based framework for the evaluation and treatment of patients with chronic nausea and vomiting.

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility Paediatrics Primary Care Stomach & H. Pylori

Citation

United European Gastroenterol J.

Published

2025

More Like This:

Coeliac disease with David Sanders

Pradeep Mundre

MASLD with Sven Francque - Part 2

Pradeep Mundre

Mistakes in the management of peritoneal malignancies and how to avoid them

Charlotte Rabl

Mistakes in hepatitis C and how to avoid them

Gonçalo Alexandrino

Mistakes in nutrition in chronic liver disease and how to avoid them

Manuela Merli

European Guideline on Chronic Nausea and Vomiting—A UEG and ESNM Consensus for Clinical Management

Carolina Malagelada