Expert Consensus on Multidisciplinary Diagnosis and Treatment of Gastroparesis in China (2025, Beijing)

doi:10.26599/AUDT.2026.250055

Abstract

Abstract:

Gastroparesis (GP) is a gastric motility disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. This expert consensus covers aspects of GP etiology (diabetes, surgery, drug-induced, idiopathic, scleroderma, etc.), symptomatology, diagnosis (scintigraphic imaging, ultrasound contrast meal assessment, and radiopaque marker gastric motility testing), and treatment (pharmacological therapy, nutritional support, traditional Chinese medicine, and interventions targeting the pylorus, such as endoscopic surgery and surgical procedures). GP significantly impacts patients' psychological well-being and quality of life, potentially leading to psychological disorders such as anxiety and depression, and also imposes a heavy economic burden on patients and society. Therefore, this expert consensus advocates for the establishment of a multidisciplinary team diagnosis and treatment model, which will further standardize and optimize the diagnosis and treatment process of GP in our country and is crucial for improving patients' therapeutic outcomes and quality of life.

Key words: Gastroparesis; Gastric emptying; Consensus; Multidisciplinary team treatment; Super minimally invasive surgery

Chen Qianqian, Yuan Yaoqian, Li Wangting, Lv Kunming, Wang Yingwei, Jiang Wenli, Guo Feng, Ye Ting, Zhang Xinsheng, Pang Jichao, Ning Bo, Shao Qun, Li Yi, Lyu Zhaohui, Liu Yinghua, Liang Yingkui, Wang Ruimin, Luo Yukun, Linghu Enqiang. Expert Consensus on Multidisciplinary Diagnosis and Treatment of Gastroparesis in China (2025, Beijing). Advanced Ultrasound in Diagnosis and Therapy, 2026, 10(1): 1-19.

Figures/Tables 5

Table 1

Table 2

Gastroparesis Cardinal Symptom Index (GCSI)"

	None	Very mild	Mild	Moderate	Severe	Very severe
Note: (1) Scoring Method: Participants are required to select the most appropriate score for the severity of each symptom over the past two weeks. If the symptom is absent, it is scored as 0; if the symptom is very mild, it is scored as 1; if the symptom is mild, it is scored as 2; if the symptom is moderate, it is scored as 3; if the symptom is severe, it is scored as 4; and if the symptom is very severe, it is scored as 5. (2) Evaluation Criteria: The GCSI consists of three subscales to assess key symptoms associated with gastroparesis, specifically nausea/vomiting, postprandial fullness/early satiety, and bloating. The nausea/vomiting subscale includes three items: nausea, dry heaving, and vomiting. The postprandial fullness/early satiety subscale includes four items: stomach bloating, inability to complete a normal-sized meal, feeling overly full after meals, and loss of appetite. The bloating subscale includes two items: bloating and noticeable enlargement of the stomach or abdomen. Patients are asked to rate the severity of symptoms on a scale from none to very severe, corresponding to scores of 0, 1, 2, 3, 4, and 5. The score for each subscale is the average score of its related items, and the GCSI score is the average of the three subscale scores. A higher score indicates more severe gastroparesis symptoms. If one of the subscale scores is missing, the GCSI score cannot be calculated.
1. Nausea (feeling discomfort in the stomach, as if about to vomit or vomiting)	0	1	2	3	4	5
2. Dry Heaving (feeling like vomiting, but nothing is expelled)	0	1	2	3	4	5
3. Vomiting	0	1	2	3	4	5
4. Bloating	0	1	2	3	4	5
5. Inability to consume a normal amount of food	0	1	2	3	4	5
6. Feeling overly full after meals	0	1	2	3	4	5
7. Loss of appetite	0	1	2	3	4	5
8. Bloating (feeling the need to loosen clothing)	0	1	2	3	4	5
9. Significant enlargement of the stomach or abdomen	0	1	2	3	4	5

Table 2

Table 3

GP therapeutic drugs summary table."

Medication	Dose	Side effects and precautions
1. Prokinetic drugs
Metoclopramide	5-10 mg tid or qid; 10-20 mg per injection, not exceeding 0.5 mg/kg per day	Can cross the blood-brain barrier, risk of tardive dyskinesia, hyperprolactinemia, and extrapyramidal side effects
Domperidone	10-20 mg tid	Increases the risk of hyperprolactinemia and cardiovascular events
Itopride	50 mg tid	Allergies, headache, sleep disturbances, abdominal pain, diarrhea, constipation, leukopenia
Mosapride	5 mg tid	Headache, abdominal pain, diarrhea, possible ECG abnormalities
Prucalopride	2 mg qd	Headache, nausea, diarrhea, occasional palpitations
Erythromycin	40-250 mg tid; 125 mg twice daily for nausea and vomiting	Liver dysfunction, intestinal flora imbalance or secondary infections, increased risk of sudden cardiac death, ototoxicity at high doses
2. Antiemetic drugs
Ondansetron	4-8 mg bid or tid	Maximum 8 mg daily for liver dysfunction, avoid after abdominal surgery to prevent masking symptoms of ileus or gastric distension
Chlorpromazine	12.5-25 mg tid or qid	Extrapyramidal reactions, hyperprolactinemia, palpitations, dry mouth, constipation, blurred vision
Diphenhydramine	12.5-25 mg tid	Drowsiness, dizziness, dry mouth, fatigue
Aprepitant	80 mg qd	Elevated ALT, fatigue
3. Pain management drugs
3.1 Tricyclic antidepressants
Nortriptyline	25-100 mg/day	Drowsiness, QT interval prolongation, arrhythmia
3.2 Serotonin-norepinephrine reuptake Inhibitors
Duloxetine	60-120 mg/day	Dizziness, nausea, dry mouth, insomnia
3.3 Anticonvulsants
Gabapentin	> 1200 mg/day, divided doses	Eosinophilia, angioedema, drowsiness, dizziness, withdrawal rebound
Pregabalin	100-300 mg/day, divided doses	Dizziness, drowsiness, dry mouth, edema, blurred vision, severe cases can lead to angioedema, increased risk of adverse reactions with sudden discontinuation
3.4 Other antidepressants
Mirtazapine	7.5-30 mg/day	Drowsiness, orthostatic hypotension, tremor, muscle cramps (rare)

Table 3

Figure 1

Figure 2

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Evidence level	Definition
Evidence quality
High (A)	Highly confident that the observation value is close to the true value
Medium (B)	Moderately confident in the observation value: the observation could be close to the true value, but could also differ significantly
Low (C)	Limited confidence in the observation value: the observation may differ greatly from the true value
Very Low (D)	Almost no confidence in the observation value: the observation may differ drastically from the true value
Recommendation Strength
Strong recommendation	A strong recommendation to support or oppose an intervention, with benefits outweighing harms
Weak recommendation	A recommendation to support or oppose an intervention, with uncertain benefits and harms