Gastroparesis occurs in an estimated 13.8 to 24.2 in 100,000 adults, with females representing approximately three-fourths of the cases. Survey studies in the larger data bases find higher rates but commonly include some clients who have gastrography but not evidence of gastris emptying objectively shown. The new AGA guidelines place prevalence rates more in the area of 21.5 to 24.2 in 100,000 and emphasize the great use of medical facilities and the chronicity of such disorders. The biggest swing from previous recommendations is the emphasis on the four hour solid food gastric emptying studies over two hours, in order to insure accurateness of diagnosis. The pharmacologic guiding principles now are to use metoclopramide, erythromycin in the beginning of therapy defeating and discouraging use of domperidone, prucalopride, aprepitant, nortriptyline, buspirone, cannabinoid, pyloric botulinum toxin, gastric stimulation, and routine G-Poem, except in highly refractory cases . These changes narrow the alternatives for therapy especially when compared to previous ruling from the ACG about permitting the use of domperidone and certain surgical procedures earlier in the course of treatment. The practical effect of all this on clinical medicine will be the necessity of having all diagnostic order sets correlate with the four hour standard, sending personnel back to school about medication stop suggestions before obtaining the studies and auditing quarterly all this being done. Treatment avenues should be directed towards evidence based medication, with closer and stricter period of duration and comfort checks for possible side effects. Centres which are using invasive or investigational procedures must attempt to frame such procedures in the area of late stage procedures and organize referral and patient instruction changes accordingly to these precepts.