Diabetic Gastroparesis in Evolution.

Abstract

Diabetic gastroparesis (DGp) is a chronic and often debilitating complication of diabetes mellitus, characterized by delayed gastric emptying in the absence of mechanical obstruction. Over the past 6 decades, our understanding of DGp has evolved considerably. Clinically, DGp presents with symptoms such as nausea, vomiting, early satiety, bloating, and abdominal pain, which are not always proportional to the degree of gastric emptying delay, underscoring the nature of the disorder. To prepare this review, we conducted a targeted narrative synthesis of the literature, performing structured searches of PubMed, Embase, and Scopus for English-language articles published between 2013 and 2025. Articles were screened for relevance and thematically organized into domains including diagnostics, therapeutics, and emerging interventions. This review provides a comprehensive, chronological account of the evolving landscape of DGp, beginning with early clinical recognition, creation of validated characterization, development of diagnostic modalities with standardized protocols, such as gastric emptying scintigraphy, wireless motility capsule, and emerging modalities such as gas-sensing capsule, body surface gastric mapping, and dynamic gastric magnetic resonance imaging. Treatments for DGp are similarly evolving from traditional promotility dopamine receptor antagonists to nonpharmacologic strategies targeting the gut-brain axis and pylorus-directed procedures. By integrating historical perspectives with contemporary advances, this review provides context for future research directions aimed at improving patient outcomes in this challenging disorder.