STOMACH AND DUODENUM: Edited by Mitchell L. Schubert and Tilak U. ShahGastroparesis and functional dyspepsia: different diseases or different ends of the spectrum?Cangemi, David J.; Lacy, Brian E.Author Information Division of Gastroenterology & Hepatology, Mayo Clinic, Jacksonville, Florida, USA Correspondence to David J. Cangemi, MD, Mayo Clinic, Division of Gastroenterology & Hepatology, 4500 San Pablo Road, Jacksonville, FL 32224, USA. Tel: +1 904 953 6970; fax: +1 904 953 6225; e-mail: [email protected] Current Opinion in Gastroenterology: November 2020 - Volume 36 - Issue 6 - p 509-517 doi: 10.1097/MOG.0000000000000677 Buy Metrics Abstract Purpose of review This review assesses the relationship between gastroparesis and functional dyspepsia, in light of recent research assessing cause, pathophysiology and treatment. Recent findings The Gastroparesis Cardinal Symptom Index (GCSI) lacks the ability to readily distinguish functional dyspepsia from gastroparesis based on symptoms. Although prior studies found that the extent of delay in gastric emptying did not accurately predict severity of symptoms, when optimally measured, delayed gastric emptying may in fact correlate with gastroparesis symptoms. Enteric dysmotility may be an important risk factor for gastroparesis. Altered central processing may play a role in symptom generation for both gastroparesis and functional dyspepsia based on functional brain MRI. Treatment directed towards reducing low-grade inflammation and improving mucosal barrier function in the duodenum may represent a novel therapeutic target for functional dyspepsia, whereas gastric peroral endoscopy myotomy (G-POEM) remains a promising intervention for refractory gastroparesis. Summary Abnormalities on functional MRI of the brain have been identified in patients with functional dyspepsia and gastroparesis. Small bowel dysmotility and duodenal barrier dysfunction have been implicated in the pathophysiology of gastroparesis and functional dyspepsia, respectively. New treatments for functional dyspepsia may target low-grade duodenal inflammation and barrier dysfunction. The pylorus remains a target in gastroparesis. Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.