Is Gastroparesis Truly Different From Functional Dyspepsia?

Is Gastroparesis Truly Different From Functional Dyspepsia?

Vanessa M. Shami, MD, FASGE, reviewing Pasricha PJ, et al. Gastroenterology 2021 Feb 3.

Patients with functional dyspepsia (FD) and gastroparesis are commonly seen, diagnosed, and treated in gastroenterology clinics. Though we think of these diseases as two separate entities, this study aims to better understand the pathophysiology of FD compared to gastroparesis. 

Of 944 patients who had symptoms suggestive of gastroparesis over a 12-year period, 720 (76%) met the criteria for gastroparesis on scintigraphy (delayed emptying >60% at 2 hours; >10% at 4 hours), whereas 224 (24%) had normal gastric emptying study results and additionally met Rome III criteria for FD. Assessment tools used in the study included patient-reported outcomes through multiple upper gastrointestinal scoring systems and a repeat emptying study test at 48 weeks.

There was no difference in psychological or quality metrics in both groups. At 48 weeks, there was clinical improvement in 27% of the FD group and 26% of the gastroparesis group (did not vary with etiology). Interestingly, the diagnosis of gastroparesis or FD was labile over time and moved in both directions without any impact on change in symptoms. To this point, an initial diagnosis of gastroparesis was reclassified as FD in 42% of patients, based on repeat emptying results, and 37% of FD diagnoses were reclassified as gastroparesis. Finally, FD and gastroparesis shared the same characteristic neuropathology when full-thickness gastric biopsy samples were obtained in 9 nondiabetic matched control patients, which found a loss of interstitial cells of Cajal and reduced numbers of anti-inflammatory C206+ macrophages.

Vanessa M. Shami, MD, FASGE


This study demonstrates the significant symptom overlay between gastroparesis and FD. Given these findings, it is important for us to destigmatize the notion that gastroparesis is an organic disease process, whereas FD is a psychosomatic disorder. From a practice pattern standpoint, it begs the question about the need to repeat a nuclear emptying study every several years for this population. Finally, one wonders whether the risk of tardive dyskinesia exceeds the benefit for patients treated with dopamine antagonists. Future studies are needed to better understand the pathophysiology of both disease entities to help with future therapies.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.


Pasricha PJ, Grover M, Yates KP, et al.; NIDDK/NIH GpCRC consortium. Functional dyspepsia and gastroparesis in tertiary care are interchangeable syndromes with common clinical and pathological features. Gastroenterology 2021 Feb 3. (Epub ahead of print) (

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