In my experience (long) gastroparesis comes from a neuropathy. In other words, a nerve or nerves controlling motility in the gut is harmed. I am amazed that there is even a discussion of whether it occurs in MS. It does. I did not know it occurred in diabetes, but it makes sense if neuropathy is a common thing in diabetes, and I recently learned that it was, when I had foot neuropathy from a different cause (not diabetes). In Porphyria, my second dx'd disease after MS, it is very common.

I have always thought that this was the primary difference in broad symptomology between MS and Porphyria. Most MS patients seem to have considerably less abdominal pain than most Porphs. I had terrible abdominal pain for many years from 17 on, which would come and go, but was there frequently. I tried everything, and no one dx'd the cause. I of course spent years going to psychiatrists, without a lot of help, although I learned a few things from group therapy, most of them only peripherally related to my abdominal pain. I think group therapy was more effective for me than psychiatry, in every case. But did not help abdominal pain.

When I got through menopause my ab pain improved somewhat. This was probably because estrogen departed, which is a high trigger for porphyria. But the real big improvement came when I got of Porph-unsafe drugs and foods and tried to avoid environmental triggers that I didn't even know were triggers in my early life...there are many many many.

I had Obstipation several times in my earlier years (which I think was due to gastroparesis). Hard to fix but extreme medical effort would succeed. I have heard of MS patients dying of Gastroparesis, and I didn't. But sometimes felt like I would like to.

In later years, rarely Obstipation, but had it last Fall after traveling and not eating right,
and had to go to ER, where my intestinal block was remedied with an oil enema (it was
like labor getting rid of that).

I too think canned pears is an ideal remedy for constipation, but I rarely have consiptation now because I take enough magnesium.