Diagnostic Criteria and Symptom Profiles in Adult Idiopathic Gastroparesis: A Systematic Review.

Background/Aims: Adult idiopathic gastroparesis, characterized by delayed gastric emptying without mechanical obstruction, presents with symptoms such as nausea, vomiting, early satiety, and postprandial fullness. Diagnostic criteria vary across studies, leading to inconsistencies in diagnosis and management. This systematic review explores the diagnostic criteria and categorization of definite, probable, and possible idiopathic gastroparesis in the literature. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, we searched Medline, EMBASE, and Cochrane Library databases for relevant articles published in English up to January 2024. Observational studies (cross-sectional, case-control, and cohort designs) that provided diagnostic criteria for idiopathic gastroparesis were included. Data were extracted on demographics, co-existing conditions, symptoms, and diagnostic approaches. Quality was assessed using Joanna Briggs Institute checklists. Results: Of 2235 initial results, 11 studies met our inclusion criteria. Most studies were of high quality, exclusively from Western research centers, and had a preponderance of female patients (61.7% to 85.9%) with mean ages ranging from 40.0 years to 58.9 years. Diagnostic variability was noted. A definite diagnosis was most often based on clinical symptoms and positive gastric emptying scintigraphy, while probable gastroparesis was identified by suggestive symptoms with normal upper endoscopy findings. Nausea and upper abdominal pain were frequently reported symptoms. Significant overlaps were observed between idiopathic gastroparesis and functional dyspepsia. Conclusions: The findings highlight the inherent diagnostic challenges and underscores the need for confirming delayed gastric emptying to clinch an accurate diagnosis of gastroparesis. Future research should focus on developing consistent diagnostic criteria across diverse populations to improve the diagnosis and management of idiopathic gastroparesis.