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Acknowledgements This research was supported by the National Key R&D Program of China (2024YFA1212500), the National Natural Science Foundation of China projects (32171320 and 82302384), the Key Project of the Natural Science Foundation of Shaanxi Province (2025JC-QYCX-066), the National University of Singapore (NUHSRO/2020/133/Startup/08, NUHSRO/2023/008/NUSMed/TCE/LOA, NUHSRO/2021/034/TRP/09/Nanomedicine, 23-0173-A0001), the National Medical Research Council (MOH-001388-00, CG21APR1005, OFIRG23jul-0047), the National Research Foundation (NRF-000352-00), and start-up funding from Shandong Cancer Hospital (rcyj-202603) Ethics declarations Competing interests The authors declare no competing interests

Whilst these medications slow gastric emptying, severe gastroparesis (stomach paralysis) is rare but has been reported and requires specialist assessment

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Prognostic value of choline and betaine depends on intestinal microbiota-generated metabolite trimethylamine-N-oxide