A vision of the future for gastroparesis

There have been significant recent advances in understanding and treatment options for gastroparesis; however, many controversies exist and the field is rapidly changing. This chapter provides a balanced discussion as to where the field is heading and provides a glimpse of how we may view and treat gastroparesis in the future. Specifically, the rationale or mechanism, the current state of evidence, and what needs to be done to bring these diverse new approaches to clinical practice are discussed. The topics addressed are: new drugs targeting “traditional” receptors with 5-HT₄ agonists, dopamine D_2/3 antagonists, and NK₁ antagonists; new drugs targeting “new” mechanisms, specifically ghrelin agonists; modulation of M2 macrophages; neurogenesis; new devices such as transcutaneous vagal nerve stimulation in the neck and novel insights on gastric electrical stimulation; and new procedures, specifically gastric per oral endoscopic myotomy.