In diabetic patients, heartburn and poor glycemic control may be the only presenting symptoms of delayed gastric emptying. Episodes of hypoglycemia in a diabetic should prompt an evaluation for underlying gastroparesis. This is relevant for both insulin-dependent and noninsulin-dependent diabetics as even the absorption of oral hypoglycemic agents can be affected by gastroparesis. As discussed above, gastroparesis should be considered in this population as its recognition and subsequent appropriate interventions may improve glycemic control and reduce the risk of further complications.

The significant overlap of gastroparesis-related symptoms with other disorders continues to be acknowledged. Functional dyspepsia is defined as bothersome early satiety, fullness, or epigastric pain or burning [43]. The Rome IV criteria describes two subtypes of functional dyspepsia: postprandial distress syndrome and epigastric pain syndrome [43, 44]. Rome IV diagnostic criteria for postprandial distress syndrome includes bothersome postprandial fullness or early satiety severe enough to impact on regular activities or finishing a regular size meal for three or more days per week in the past three months, with a least a six-month history. Rome IV criteria for epigastric pain syndrome is bothersome epigastric pain or epigastric burning one or more days per week in the past three months, with at least a six-month history. Gastroparesis is reported in 20% of individuals with a Rome IV diagnosis of functional dyspepsia demonstrating the significant overlap in these disorders [43]. Individuals with functional dyspepsia also report high rates of nausea and heartburn, often making the distinction between functional dyspepsia and gastroparesis difficult to clinically discern.

In individuals with a diagnosis of gastroparesis , the stomach may not be the only affected organ as these individuals appear to have higher rates of esophageal dysmotility, small intestinal dysmotility, and colonic dysmotility [45]. Therefore, a more extensive evaluation may be warranted based on symptoms. The SmartPill (Medtronic, Minneapolis, MN) wireless motility capsule may be considered as this can provide information not only regarding the strength and frequency of antral contractions along with gastric emptying time but also of small intestinal transit, colonic transit, and global gastrointestinal transit times [46]. In addition, assessment with a wireless motility capsule can easily be performed in an outpatient setting [47].

Individuals presenting with immune disorders, neurological disorders, or connective tissue disorders in addition to gastrointestinal symptoms should be evaluated for gastroparesis and other gastrointestinal motility disorders, given the association in these populations [19, 48–51]. Research is ongoing that will eventually elucidate the pathophysiological mechanisms of gastrointestinal dysmotility, and with that, hope for better treatments exist.