Achieving Symptom Control in the Treatment of Gastroparesis: From Pills to Pacing

Background Gastroparesis is a chronic disorder of the stomach characterized by delayed emptying without mechanical obstruction. Affected patients experience nausea, vomiting, and a feeling of fullness. Achieving sufficient symptom control remains challenging. Aims The aim of this retrospective study was to analyse the use and effectiveness of current treatment options employed in a step-up approach: 1.Dietary changes, 2.pharmacological treatment (prokinetic drugs including domperidone and prucalopride, and laxatives), 3.pyloric interventions (endoscopic balloon dilation, gastric per-oral endoscopic myotomy (G-POEM), laparoscopic surgical pyloromyotomy), and 4.gastric electrical stimulation (GES, EnterraTM). Methods All patients treated for gastroparesis at a tertiary hospital by a dedicated team between 01/2025 and 01/2026 were included. Diagnosis was confirmed by gastric emptying scintigraphy. Exclusion criteria were previous upper gastrointestinal tract surgery, concomitant hiatal hernia or gastroesophageal reflux disease (GERD), and intestinal failure. Main outcome was sufficient symptom control at the latest available follow-up defined as improved or contained symptoms without need for treatment escalation. Results Fifty patients were included. Median age was 39 years (IQR 25-57), 66% were female. Reasons for gastroparesis was idiopathic in 80%, diabetes in 8%, and rheumatologic or neurologic disease in 12%. Most frequent symptoms were feeling of fullness (82%) and nausea (74%). Sufficient symptom control following conservative treatment was achieved in 13 patients (26%). Eighteen patients (36%) underwent at least one pyloric intervention [G-POEM (n=5), dilatation (n=10), laparoscopic pyloromyotomy (n=5)], with five patients (10%) achieving sufficient symptom control. Fifteen patients (30%) received a GES device, of which two-thirds (n=10) achieved sufficient symptom control. Twenty patients (40%) had at least two interventions during their treatment course. Conclusion Adequate symptom control often requires escalation beyond conservative treatment. Many patients need multiple interventions, emphasizing the chronic nature of gastroparesis. These findings highlight the importance of an individualized, multimodal treatment approach and the need to further investigate predictors of treatment response.