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UEG Standards and Guidelines

Consensus

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Abstract

Background

Gastroparesis is a condition characterized by epigastric symptoms and delayed gastric emptying (GE) rate in the absence of any mechanical obstruction. The condition is challenging in clinical practice by the lack of guidance concerning diagnosis and management of gastroparesis.

Methods

A Delphi consensus was undertaken by 40 experts from 19 European countries who conducted a literature summary and voting process on 89 statements. Quality of evidence was evaluated using grading of recommendations assessment, development, and evaluation criteria. Consensus (defined as >=80% agreement) was reached for 25 statements.

Results

The European consensus defined gastroparesis as the presence of symptoms associated with delayed GE in the absence of mechanical obstruction. Nausea and vomiting were identified as cardinal symptoms, with often coexisting postprandial distress syndrome symptoms of dyspepsia. The true epidemiology of gastroparesis is not known in detail, but diabetes, gastric surgery, certain neurological and connective tissue diseases, and the use of certain drugs recognized as risk factors. While the panel agreed that severely impaired gastric motor function is present in these patients, there was no consensus on underlying pathophysiology. The panel agreed that an upper endoscopy and a GE test are required for diagnosis. Only dietary therapy, dopamine-2 antagonists and 5-HT4 receptor agonists were considered appropriate therapies, in addition to nutritional support in case of severe weight loss. No consensus was reached on the use of proton pump inhibitors, other classes of antiemetics or prokinetics, neuromodulators, complimentary, psychological, or more invasive therapies. Finally, there was consensus that gastroparesis adversely impacts on quality of life and healthcare costs and that the long-term prognosis of gastroparesis depends on the cause.

Conclusions and Inferences

A multinational group of European experts summarized the current state of consensus on definition, symptom characteristics, pathophysiology, diagnosis, and management of gastroparesis.

Keywords: consensus, endoscopy, gastric emptying, gastroparesis, guideline, prokinetic

United European Gastroenterology (UEG) and European Society for Neurogastroenterology and Motility (ESNM) consensus on gastroparesis

Jolien Schol

Publisher

European Society of Neurogastroenterology and Motility

Guideline

Consensus

Topics

Neurogastroenterology & Motility

Citation

United European Gastroenterol J.2021;9:287–30

Published

2021

UEG Mistakes In Articles

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Mistakes in rumination syndrome and how to avoid them

Alberto Ezquerra-Durán, Elizabeth Barba Orozco

Topics

Neurogastroenterology & Motility

Citation

Ezquerra-Durán A and Barba-Orozco E. Mistakes in rumination syndrome and how to avoid them. UEG Education 2025; 25: 10-13.

Published

2025

UEG Mistakes In Articles

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Metabolic Dysfunction-Associated Steatotic Liver Disease (MASLD) is a subclassification of steatotic liver disease (SLD), defined as the presence of excess triglyceride storage in the liver in conjunction with at least one cardiometabolic risk factor and no other discernible cause.1 Cirrhosis secondary to MASH is the most common cause of liver disease in the world and is the fastest-growing indication for liver transplantation, but it also has a >50% recurrence rate post-transplantation.

Mistakes in metabolic dysfunction associated steatotic liver disease and how to avoid them

Sarah Townsend, Philip Newsome

Topics

Hepatobiliary

Citation

Townsend SA and Newsome PN. Mistakes in nonalcoholic fatty liver disease and how to avoid them. UEG Education 2017; 17: 39–41.

Published

2024

UEG Mistakes In Articles

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Diarrhoea, acute or chronic, is a common gastrointestinal symptom in healthcare. In most cases, acute diarrhoea in healthy individuals requires limited diagnostic and therapeutic efforts, except for the replacement of fluid electrolytes, and stool culture in severe occurrences. Acute diarrhoea is often self-limiting due to short-lived reactions to food intake and bacterial or viral infections. However, diarrhoea can persist and fulfil definitions of chronicity when a month or more has passed since the onset. Here we discuss some basic mistakes that should be avoided when managing unexplained non-bloody diarrhoea that persists beyond the acute setting. In this context, the term 'unexplained' refers to a patient without apparent alarm features and where initial consultations have failed at making a diagnosis. We used an evidence-based approach and included aspects predominantly based on clinical experience when appropriate.

Mistakes in the management of unexplained diarrhoea and how to avoid them

Magnus Simrén, Hans Törnblom

Topics

Neurogastroenterology & Motility

Citation

Törnblom H and Simrén M. Mistakes in the management of unexplained diarrhoea and how to avoid them. UEG Education 2022; 22: 16–19.

Published

2022

UEG Mistakes In Articles

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Eosinophilic oesophagitis (EoE) is a chronic immune-mediated inflammatory condition that is confined to the oesophagus. Clinically, EoE is characterized by symptoms of oesophageal dysfunction; histologically, by eosinophil-predominant inflammation.1,2 At present, EoE is the second-most frequent cause of chronic oesophagitis (gastro-oesophageal reflux disease [GORD] is the primary cause) and the foremost cause of dysphagia and food impaction in young adults and children.

Mistakes in eosinophilic oesophagitis and how to avoid them

Alfredo J. Lucendo, Javier Molina-Infante

Topics

Oesophagus

Citation

Molina-Infante J and Lucendo AJ. Mistakes in eosinophilic oesophagitis and how to avoid them. UEG Education 2017: 17; 6–9.

Published

2024

UEG Standards and Guidelines

Clinical Practice Guideline

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Abstract

Background

There are several options for the surgical management of GERD in adults. Previous guidelines and systematic reviews have compared the effects of total fundoplication versus pooled effects of different techniques of partial fundoplication.

Objective

To develop evidence-informed, trustworthy, pertinent recommendations on the use of total, posterior partial and anterior partial fundoplications for the management of GERD in adults.

Methods

We performed an update systematic review, network meta-analysis, and evidence appraisal using the GRADE and the Confidence in Network Meta-Analysis methodologies. An international, multidisciplinary panel of surgeons, gastroenterologists, and a patient representative reached unanimous consensus through an evidence-to-decision framework to select among multiple interventions, and a Delphi process to formulate the recommendation. The project was developed in an online authoring and publication platform (MAGICapp), and was overseen by an external auditor.

Results

We suggest posterior partial fundoplication over total posterior or anterior 90° fundoplication in adult patients with GERD. We suggest anterior >90° fundoplication as an alternative, although relevant comparative evidence is limited (weak recommendation). The guideline, with recommendations, evidence summaries and decision aids in user friendly formats can also be accessed in MAGICapp: https://app.magicapp.org/#/guideline/j20X4n.

Conclusion

This rapid guideline was developed in line with highest methodological standards and provides evidence-informed recommendations on the surgical management of GERD. It provides user-friendly decision aids to inform healthcare professionals' and patients' decision making.

Key summary

Various surgical options exist for the management of GERD in adults.
We summarized evidence through network meta-analysis of interventions.
We suggest partial posterior fundoplication over total posterior or anterior 90° fundoplication.
We suggest anterior >90 degrees may be an alternative.

Keywords: AGREE‐S, fundoplication, GERD, guideline, Nissen, Toupét

UEG and EAES rapid guideline: Update systematic review, network meta-analysis, CINeMA and GRADE assessment, and evidence-informed European recommendations on surgical management of GERD

Sheraz Markar

Publishers

European Society for Paediatric Gastroenterology, Hepatology and Nutrition, European Association for Endoscopic Surgery and other interventional techniques