Gastric Evacuation Research Articles

Respiratory and digestive responses of postprandial Dungeness crabs, Cancer magister, and blue crabs, Callinectes sapidus, during hyposaline exposure

Respiratory responses and gastric processing were examined during hyposaline exposure in two crab species of differing osmoregulatory ability. The efficient osmoregulator, Callinectes sapidus, displayed an immediate increase in oxygen uptake when exposed to low salinity in isolation. In contrast, the weak osmoregulator, Cancer magister, showed no change in oxygen uptake upon acute exposure (<6 h), but slight increases in oxygen uptake tended to occur over longer time scales (12-24 h). These changes were likely attributable to an increase in avoidance activity after 6 h hyposaline exposure. Following feeding in 100% SW, oxygen uptake doubled for both species and remained elevated for 15 h. When postprandial crabs were exposed to low salinities, C. sapidus were able to sum the demands of osmoregulation and digestion. Thus, gastric processes continued unabated in low salinity. Conversely, postprandial C. magister prioritized responses to low salinity over those of digestion, resulting in a decrease in oxygen uptake when exposed to low salinity. This decrease in oxygen uptake corresponded to a reduction in the rate of contraction of the pyloric stomach and a subsequent doubling of gastric evacuation time. The current study is one of the few to illustrate how summation or prioritization of competing physiological systems is manifested in digestive processes.

Effect of feed composition and temperature on food consumption, growth and gastric evacuation of juvenile Atlantic cod ( Gadus morhua L.) and haddock ( Melanogrammus aeglefinus L.)

During sea-cage rearing, Atlantic cod and haddock are fed commercial diets that have high protein content (∼ 50–58%) and are designed for optimum growth at temperatures of 10–12 °C. However, these fish spend several months at temperatures below 5 °C in Atlantic Canada, and there are data to suggest that growth could be enhanced at low water temperatures by feeding a diet with lower protein (LP) content and higher lipid. Thus, we explored how dietary protein and lipid (P/L) levels of 42/16 (low protein, LP diet) and 55/11 (high protein, HP diet) and water temperature (11, 6 and 2 °C) influenced the specific growth rate (SGR), hepatosomatic index (HSI), adjusted specific growth rate (SRG A), food consumption (FC), gross conversion efficiency (GCE) and gastric evacuation (GE) of juvenile Atlantic cod and haddock. Several temperature and species-specific effects were observed for the measured variables. Significant decreases in SGR, SGR A and FC (range 60–96%) were evident for both species when reared at 2 vs. 11 °C. The GCE of haddock was 46 and 31% (for HP and LP diets, respectively) higher than that measured for Atlantic cod at 11 °C, but 35 and 40% lower at 2 °C. With regards to the effects of dietary protein level, it was found that while feed composition did not affect growth rate (with the exception of haddock at 11 °C) or GE, GCE was significantly lower in fish fed the LP diet. These results indicate that 1) low temperatures present a particular challenge to haddock aquaculture; and 2) based on the similar growth rate, but lower GCE values, there is no advantage to feeding an LP diet even at cold temperatures.

Sablefish Predation on Juvenile Pacific Salmon in the Coastal Marine Waters of Southeast Alaska in 1999

AbstractAt‐sea observations of predation by age‐1 and older (age‐1+) sablefish Anoplopoma fimbria on juvenile Pacific salmon Oncorhynchus spp. were combined with laboratory studies to determine gastric evacuation rates and were used to estimate summer predation impact in the northern region of Southeast Alaska. In June and July 1999, up to 63% of sablefish examined from trawl catches in strait habitat had each consumed one to four juvenile pink salmon O. gorbuscha, chum salmon O. keta, or sockeye salmon O. nerka. In two laboratory experiments, field‐captured sablefish were acclimated without food in compartmentalized flow‐through tanks with conditions manipulated to reflect the photoperiod and temperature regimes of summer. These sablefish were each offered one whole, preweighed juvenile chum salmon; consumption events were observed, and the sablefish were then sacrificed at predetermined time intervals. Prey biomass remaining in the stomach of each sablefish predator was weighed, and an exponential model of the decline in percent biomass over time was used to yield instantaneous evacuation rates of 0.049 at 12°C and 0.027 at 7°C. From field data combined with model‐derived estimates of meal frequency, we estimated that 0.8‐6.0 million juvenile salmon were consumed by age‐1+ sablefish in the 500‐km2 area of Icy Strait during a 33‐d period. Moreover, a 10‐year time series of catches indicated that 1999 was a year of unusually high age‐1+ sablefish abundance and relatively low juvenile salmon abundance. We speculate that sablefish predation in 1999 could have affected abundance of out‐migrating juveniles and contributed to low harvests of returning adult pink salmon in 2000 and adult chum salmon in 2002. Our results suggest that sablefish predation on juvenile Pacific salmon can occur during episodic strong year‐classes of sablefish and may affect adult salmon returns.

A generic model to estimate food consumption: linking von Bertalanffy’s growth model with Beverton and Holt’s and Ivlev’s concepts of net conversion efficiency

In this paper, a mathematical derivation is presented that links von Bertalanffy’s growth model with the concept of net conversion efficiency of Beverton and Holt, aiming at the development of an equation that can calculate food consumption rates of wild populations from parameters of the von Bertalanffy growth equation and an estimate of the net food conversion efficiency of Beverton and Holt. The derivation is based on Pauly’s version of the generalized von Bertalanffy equation, which allows the allometric exponent of the anabolism term to differ from 2/3, as in the standard von Bertalanffy equation. As a side product, a general model is formulated that describes the gross growth conversion efficiency (K1 of Ivlev) as a function of weight of the organism. The new equations for the estimation of food consumption are applied in two case studies, North Sea cod ( Gadus morhua ) and whiting ( Merlangius merlangus ), for which a variety of consumption estimates is available from conventional gastric evacuation-based methods. The new method produces results that show a similar degree of variability as was observed in various applications of the gastric evacuation method.

Comparative evaluation of Glasgow Coma Score and gag reflex in predicting aspiration pneumonitis in acute poisoning

Purpose The purpose of the study was to assess the incidence of aspiration pneumonitis (AP) and its association with gag reflex and Glasgow Coma Score (GCS). Materials and Methods In a retrospective analysis study after prospective data collection, 155 poisoned patients with GCS less than or equal to 12 were evaluated. An assessment of GCS and the quality of gag reflex was made on arrival and recorded. Intubation status before gastrointestinal decontamination was noted. All patients were subsequently followed for developing of AP. Results The incidence of AP was 15.5%, with significant variance among patients with respect to the gag reflex, GCS, and the performance of intubation. A logistic regression model for predicting AP contained the following predictors: GCS (odds ratio [OR], 0.43; 95% confidence interval [CI], 0.30-0.62), intubation (OR, 0.07; 95% CI, 0.01-0.49), organophosphate ingestion (OR, 1.39; 95% CI, 0.96-2.01), and gastric evacuation (OR, 4.29; 95% CI, 0.94-9.51). In patients with reduced gag reflex, variations in GCS were associated with AP (OR, 0.43; 95% CI, 0.20-0.90), whereas in patients with absent gag reflex, age was the most important predictor of AP (OR, 2.67; 95% CI, 0.99-7.22). Conclusions A reduced GCS and a nonintubated trachea are associated with an increased incidence of AP.

Diel Feeding Chronology, Gastric Evacuation, and Daily Food Consumption of Juvenile Chinook Salmon in Oregon Coastal Waters

AbstractThe diel feeding periodicity of juvenile Chinook salmon Oncorhynchus tshawytscha was determined from stomachs collected in coastal waters off Oregon in 2000 and 2003. Juvenile Chinook salmon exhibited a diurnal feeding pattern with morning and evening feeding periods. There were differences in the duration and magnitude of the dawn and dusk peaks between the 2 years. Gastric evacuation rates of euphausiid meals were estimated from laboratory experiments at 9.3, 10.7, and 13.9°C. Based on an exponential model, the instantaneous evacuation rates at these three temperatures were 0.0407, 0.0589, and 0.0807 per hour, respectively. The daily ration of juvenile Chinook salmon in Oregon coastal waters in 2000 and 2003 was estimated using three models. Using laboratory‐derived evacuation rates, the Elliott and Persson and Eggers models produced daily ration estimates of 2.04% and 2.57% of body weight (BW), respectively, in 2000 and 2.93% and 2.46%BW in 2003. The MAXIMS model, which does not rely on laboratory‐derived evacuation rates, produced higher estimates of daily ration (3.84% and 4.28%BW). Our diel feeding chronology, gastric evacuation rate, and daily ration estimates for juvenile Chinook salmon were comparable to those of other juvenile salmonids.

Performance factors, body composition and digestion characteristics of gilthead sea bream (Sparus aurata) fed pelleted or extruded diets

The effects of steam pelleting or extrusion of a commercial feed on performance of 2 g (small) and 40 g (large) gilthead sea bream was studied. In addition the apparent digestibility of diets, gastric evacuation time (GET) and trypsin and amylase activities were measured in large fish. Fish size significantly increased protein and energy productive value, body protein and lipid, liver glycogen and liver lipid, however decreased daily growth index, feed intake and feed utilization, body moisture and hepatosomatic index. Extrusion processing decreased feed intake, more strongly for small fish, and increased daily growth index, feed utilization, protein and energy productive value, body protein and lipid. Digestibility of starch and energy increased with extrusion and GET of extruded feed was double that of steam-pelleted conditioned feed (i.e. 544 min versus 284 min). Digestive enzyme activities approached maximum values after 240 min for the pelleted diet, while those of the extruded continued to increase, at higher rates for amylase than trypsin. Pelleted diet indicated higher moisture for stomach digesta, while the moisture of the intestinal precipitate indicated a higher water-binding capacity for the extruded diet. The overall results indicate a better assimilation of the extruded diet, which could result from its prolonged gastric evacuation.

Laboratory experiments on the gastric evacuation of juvenile herring ( Clupea harengus L.)

Laboratory experiments were conducted on groups of 9.9 to 13 cm (mean) total length (L T) juvenile herring ( Clupea harengus L.) to describe the temperature dependency of the gastric evacuation. Experiments were conducted at 13 and 16 °C. The parameters of the general gastric evacuation model were B = 0.953 and R = 0.082 at 13 °C and B = 1.323 and R = 0.843 at 16 °C indicating an exponential evacuation. The evacuation constants of the exponential gastric evacuation model were R = 0.098 at 13 and R = 0.202 at 16 °C resulting in a temperature dependency parameter (A) of 0.241. The internal dynamics of the stomach and its storage capacity were studied by the use of stained copepods. Investigations on the functional response of herring to different food densities were described by the Michaelis-Menten equation. Our experimental design allowed us to test the hypothesis of Richter et al. [Richter, H., Lückstädt, C., Schlechtriem, C., Focken, U., Becker, K., 2002. Do the fish stomach content models currently used for daily ration estimation really work? Evidence of violation of a basic assumption concerning stomach evacuation rates. Arch. Fish. Mar. Res. 49 (3), 171–188] that fish have two evacuation modes, one evacuation constant while only evacuating food and a significant higher constant while feeding, which would question the basic assumption of most consumption models, that only use one evacuation constant for consumption estimates. The experiments of Richter et al. [Richter, H., Lückstädt, C., Schlechtriem, C., Focken, U., Becker, K., 2002. Do the fish stomach content models currently used for daily ration estimation really work? Evidence of violation of a basic assumption concerning stomach evacuation rates. Arch. Fish. Mar. Res. 49 (3), 171–188] suggested that a doubled constant would give the best match of observed feeding and estimates of consumption models. Through the results of simulations of two experiments in which we combined observed snatching rates, estimated evacuation constants and particle weights of consumed copepods, we cannot support this hypothesis. A doubled evacuation constant did not improve our simulations, on the contrary the simulations with a doubled constant gave a worse fit with our observed values. Knowledge on the gastric evacuation is a prerequisite for the evaluation of a potential top-down impact of this zooplanktivorous species on the plankton community.

Daily ration and feeding activity of juvenile hake in the central Mediterranean Sea

We investigated daily ration, feeding rhythms and gastric evacuation rates of juvenile (&lt;16 cm total length) European hake Merluccius merluccius, using stomach samples collected during four 24-hour trawl surveys carried out in 2001–2002 on the continental shelf-break (from 120 m to 160 m in depth) off the western coast of central Italy (central Mediterranean Sea). In each survey 8 hauls of 30 minutes were performed every three hours throughout the 24-hour period to cover the entire diel cycle. Diet of juvenile hake was mostly composed of the euphausiid Nyctiphanes couchii, showing a peak in stomach contents during early morning followed by a daytime decrease. Fullness index (%FI) was generally higher during sunrise when migratory activity ceased and juvenile hake return to the bottom after feeding. Concerning the hake abundance the highest density value was obtained in May during the recruitment period.Two independent daily ration estimates were produced. First, an empirical attempt to estimate the daily amount of food consumed was obtained by back-calculating the fresh weight of euphausiid prey ingested by juvenile hake. Estimated values ranged from 4.96–5.89% body wet weight (%BW). Second, the daily ration was computed applying the exponential gastric evacuation models proposed by Elliot &amp; Persson (1978) and Eggers (1979). Daily ration values obtained using these consumption models produced a considerable (15–20%) underestimation of consumption rate for juvenile hake.

Effect of feeding regime and fish size on weight gain, feed intake and gastric evacuation in juvenile Australian snapper Pagrus auratus

We investigated the interactive effects of nine feeding regimes (1 feeding early, 1 feeding late, 2 feedings early, 2 feedings late, 4 feedings, 4 feedings early, 4 feedings late, 6 feedings or 8 feedings per day; hereafter IFE, 1FL, 2FE, 2FL, 4F, 4FE, 4FL, 6F or 8F, respectively) and two fish sizes (small ≈ 5 g or large ≈ 20 g) on the harvest weight, feed intake and feed conversion ratio (FCR) of juvenile Australian snapper reared under an 18 L:6D photoperiod at a temperature of 23 °C for 42 days. At the completion of the feeding study, small or large fish which had been accustomed to 1FE or 1FL were sacrificed to model gastric evacuation of a single meal. The feeding study indicated that optimum to maximum weight gain and FCR in juvenile snapper can be achieved by feeding fish to apparent satiation twice per day. This regime equated to relative feed intakes of 36 or 47 g kg BW − 1 day − 1 for large or small snapper, respectively. In addition, there were no improvements in weight gain as a consequence of feeding a similar number of feeds (i.e. once, twice or four times) earlier in the day as opposed to later in the day. Size heterogeneity in both groups of snapper measured as the coefficient of variation in harvest weight (CV hw), was not affected by feeding regime, but smaller snapper recorded slightly higher CV hw (0.14) than larger juveniles (0.11). The gastric evacuation rates (GER) of small or large snapper fed a single meal proved to be similar (relative feed content Combined = 2.733 ± 0.195 × exp (− 0.139 ± 0.013) ; R 2 = 0.72), with approximately half the meal passed within 5 h and the whole meal cleared from the stomach within 16–20 h. This information will help operators of snapper hatcheries/nurseries plan their feeding regimes and assist with benchmarking performance.

X-Ray usability for determination of gastric and digestive track evacuation time in meagre Argyrosomus regius Asso, 1801.

X-Ray usability for determination of gastric and digestive track evacuation time in meagre Argyrosomus regius Asso, 1801.

Ultrasonographic evaluation of gallbladder dysfunction in patients with functional dyspepsia

The study aims to observe the gallbladder emptying in patients with functional dyspepsia, by means of ultrasonographic method described by Dodd et al. We measured the corelation between symptoms and presence of gallbladder dysfunction after a solid meal. Study also aims to evaluate the influence of Helicobacter pylori infection on gallbladder motility. Gallbladder and gastric evacuation were analized for identiffication of coordination problems between gastric and biliary motility.

Differential digestion and evacuation rates of prey in a warm‐temperate grouper, gagMycteroperca microlepis(Goode &amp; Bean)

Prey‐specific gastric evacuation rates and digestion state indices were modelled for gagMycteroperca microlepis, a large warm‐temperate grouper, consuming meals of either baitfish (scaled sardineHarengula jaguana) or crab (purple swimmer crabPortunus gibbesii). Power exponential models best fit the wet and dry mass gastric evacuation data and the average digestion indices over post‐prandial time (PPT), regardless of prey type or gag size (AdjustedR2≥ 0·79). Gag mass (M) or total length (LT) incorporated into an expanded power exponential model, along with exponential scalars, resulted in highly predictive (R2≥ 0·87) gastric evacuation and average digestion state models. The expanded power exponential models fit to the baitfish and crab wet mass gastric evacuation data differed significantly (Kimura’s likelihood ratio test (LRT), bothP&lt; 0·001). Gag consuming crab showed a digestive lag period of at least 4 h (wet mass) and took a longer time to complete digestion relative to gag consuming baitfish. Gag, as well as many other warm‐temperate and tropical groupers, consume a mixture of fish and crab prey and they will therefore require the development of a consumption model that incorporates mixed‐prey gastric evacuation models.

Photoperiod and feeding interval requirements of juvenile mulloway, Argyrosomus japonicus

Two experiments were completed to determine the most efficient feeding interval and photoperiod for rearing juvenile mulloway, Argyrosomus japonicus. The first, a two-factor experiment incorporating three photoperiods (12L:12D, 18L:6D and 24L:0D), and five feeding intervals (1, 3, 6, 12 and 24 h between feeds), examined the effects on somatic growth rate, feeding efficiency and survival of juvenile mulloway (2.7±0.5 g). The growth indices tested included fish weight, length, food conversion ratio — FCR, condition factor — CF, and the coefficient of variation of weight — CVwt. No interactions were found for any variables measured with the result that photoperiod and feeding interval outcomes were discussed separately. The 12L:12D photoperiod produced significantly poorer survival than other photoperiods, however feeding interval did not influence survival. The 24L:0D photoperiod led to significantly reduced growth rates, compared to that of 12L:12D and 18L:6D. The CF of the 12L:12D photoperiod was reduced compared to other photoperiods as the fish were significantly longer in comparison to their weight, however the FCR of the 12L:12D photoperiod was significantly better than the other photoperiods. The 24 h feeding interval resulted in reduced lengths and weights than fish from other feeding intervals, however no differences occurred between the 1, 3, 6 and 12 h feeding intervals. The CVwt was not affected by either photoperiod or feeding interval. The second experiment assessed gastric evacuation by juvenile mulloway after being fed once to satiation. Stomach contents were evacuated at a steady rate with a 50% reduction in stomach fullness after 10 h and 100% evacuation of stomach contents after 20 h. These experiments suggest that a photoperiod of 18L:6D and a 12 h feeding interval is the most efficient regime to produce high growth rates and survival for juvenile mulloway.

Precision of ingestion time and evacuation predictors for individual prey in stomachs of predatory fishes

Without evaluating precision, gastric evacuation models in combination with stomach data are widely used to investigate the feeding biology of wild predatory fishes. Assuming each predator individual to operate with its own evacuation rate parameter, the precision of estimated ingestion times for individual prey in the stomachs of predatory fishes was derived in this study. This way, the variability of gastric evacuation not accounted for by a deterministic model of gastric evacuation was described. The variability of initial body mass of ingested prey was included as well. General values 0.03 and 0.10 of the coefficients of variation σ m and σ e were obtained for the square root of initial prey mass and the evacuation rate parameter, respectively. They were estimated from length–mass data on a variety of fresh prey fishes and from data on gastric evacuation in the predatory gadoids whiting ( Merlangius merlangus), Atlantic cod ( Gadus morhua), and saithe (pollock) ( Pollachius virens). Deriving the variance of gastric evacuation rate, evacuation time, and remaining prey mass, the study also established a basis for statistical analyses of the results obtained from laboratory experiments on gastric evacuation.

Predicting ingestion times of individual prey from information about stomach contents of predatory fishes in the field

In contrast to previous approaches, and incorporating interactions between individual prey in the stomach, the cylinder model of gastric evacuation predicted accurately the ingestion times of individual prey recovered from stomachs of predatory gadoids sampled in laboratory experiments. For application to field situations, estimates of the variance σ τ 2 = ( σ τ , e 2 + σ τ , m 2 ) of the predicted time interval τ between prey ingestion and stomach sampling were obtained from generalised considerations about the errors of estimated gastric evacuation rate ( σ τ,e ≅ 0.10 τ) and prey size at ingestion ( σ τ, m increased from 1 h to 2.5 h with increasing number and body size of other prey in the stomach). The bias originating from non-observable prey (that were completely evacuated from the stomach prior to sampling) may amount to more than 20% and should be taken into consideration. In contrast, the sensitivity of τ to estimated body lengths of other prey recovered as small remains from the stomach was generally low. These error and bias considerations render possible an appraisal in advance of the precision and the accuracy and, so, of the usefulness of the method in specific field studies on the feeding biology of predatory fishes.

Seasonal change in the gastric evacuation rate of rainbow trout feeding on natural prey

Seasonal changes in the gastric evacuation rate (R) and gut contents of a wild population of rainbow trout Oncorhynchus mykiss feeding on natural prey at four water temperatures (2, 7, 9 and 12° C) were measured. The R and mass of the gut contents increased with water temperature, and prey items changed seasonally. These results suggest that the R of fish feeding on natural food depends primarily on water temperature, with their consumed prey being a secondary factor.

Prey consumption by the juvenile soles, Solea solea and Solea senegalensis, in the Tagus estuary, Portugal

The soles Solea solea and Solea senegalensis are marine flatfish that use coastal and estuarine nursery grounds, which generally present high food availability, refuge from predators and favourable conditions for rapid growth. Two important nursery grounds for these species juveniles have been identified in the Tagus estuary, one in the upper part of the estuary (nursery A) and another in the south bank (nursery B). While S. solea is only present at the uppermost nursery area, S. senegalensis is present at both nurseries. Although they are among the most important predators in these nursery grounds, there are no estimates on their food consumption or on the carrying capacity of the system for soles. The Elliott and Persson [1978. The estimation of daily rates of food consumption for fish. Journal of Animal Ecology 47, 977–993] model was used to estimate food consumption of both species juveniles in both nursery areas, taking into account gastric evacuation rates (previously determined) and 24 h sampling surveys, based on beam-trawl catches carried out every 3 h, in the summer of 1995. Monthly beam trawls were performed to determine sole densities over the summer. Density estimates and daily food consumption values were used to calculate total consumption over the summer period. Sediment samples were taken for the estimation of prey densities and total biomass in the nursery areas. Daily food consumption was lower for S. solea (0.030 g wet weight d −1) than for S. senegalensis (0.075 g wet weight d −1). It was concluded that thermal stress may be an important factor hindering S. solea's food consumption in the warmer months. Total consumption of S. solea over the summer (90 days) was estimated to be 97 kg (wet weight). Solea senegalensis total consumption in nursery A was estimated to be 103 kg, while in nursery B it was 528 kg. Total prey biomass estimated for nursery A was 300 tonnes, while for nursery B it was 58 tonnes. This suggests that food is not a limiting factor for sole in the Tagus estuary. However it was concluded that more in-depth studies into the food consumption of other species and prey availability are needed in order to determine the carrying capacity of this system for sole juveniles.

Gastric Evacuation and Daily Ration of Naturally Produced Age‐0 Chinook Salmon in Lake Ontario

AbstractAlmost 30 years after natural reproduction of Chinook salmon Oncorhynchus tshawytscha was discovered in Lake Ontario tributaries, little is known about the feeding dynamics of these fish after they enter the lake. This study assesses consumption by naturally produced age‐0 Chinook salmon as they enter the nearshore region of Lake Ontario after emigrating from the Salmon River, New York, a major U.S. tributary of Lake Ontario. Evacuation rate, estimated as a function of temperature in controlled laboratory experiments, ranged from 0.214/h at 10°C to 0.352/h at 19°C. Diel field sampling for daily ration estimates occurred on three dates in late spring (June 6, 12, and 18, 2001). Although no consistent diel feeding pattern was observed, Chinook salmon maintained an elevated gut fullness value throughout the day and did not feed after dark. Moreover, daily rations (grams [dry weight] of ration per 100 g of dry fish weight), which ranged from 27.54 (SE = 3.07) on June 12 to 33.27 (3.7) on June 6, were high compared with the values obtained in similar studies. Comparisons of daily ration estimates with bioenergetics model estimates showed that juvenile Chinook salmon were consuming prey at or above their maximum estimated daily ration. Daily ring counts of sagittal otoliths confirmed that the Chinook salmon in this investigation were naturally produced. Our results indicate that current food conditions in the nearshore waters of Lake Ontario are suitable for sustaining maximum consumption rates by naturally produced juvenile Chinook salmon that have recently migrated into the lake from spawning tributaries.

Type 1 diabetes and gastroparesis: Diagnosis and treatment

Patients with gastroparesis present with gastrointestinal symptoms and non-gastrointestinal manifestations in association with objective delays in gastric emptying. The condition complicates the course of many patients with type 1 diabetes mellitus, usually in those with longstanding poor glycemic control with other associated diabetic complications. The diagnosis is made by directed evaluation to exclude organic diseases that can mimic the clinical presentation of gastroparesis, coupled with verification of gastric retention. Current therapy relies on dietary modifications, medications to stimulate gastric evacuation, and agents to reduce vomiting. Endoscopic and surgical options are increasingly used in patients who are refractory to drug treatment.