From the Guidelines
The most effective treatment for gastroparesis involves a low-fiber, low-fat eating plan provided in small frequent meals with a greater proportion of liquid calories, as well as withdrawing drugs with adverse effects on gastrointestinal motility. This approach is supported by the most recent evidence from 2024, which suggests that dietary changes and medication adjustments can improve symptoms of gastroparesis 1.
Key Components of Treatment
- A low-fiber, low-fat eating plan with small frequent meals and a greater proportion of liquid calories may be useful in managing gastroparesis symptoms 1
- Withdrawing drugs with adverse effects on gastrointestinal motility, including opioids, anticholinergics, TCAs, GLP-1 RAs, and pramlintide, may also improve intestinal motility 1
- In cases of severe gastroparesis, pharmacologic interventions such as metoclopramide, domperidone, or erythromycin may be necessary, although their use is limited by potential side effects and efficacy 1
Medication Options
- Metoclopramide is the only FDA-approved prokinetic agent for the treatment of gastroparesis, but its use is recommended for no more than 12 weeks due to the risk of serious adverse effects 1
- Domperidone and erythromycin are alternative treatment options, although their availability and efficacy may be limited 1
Additional Considerations
- Gastric electrical stimulation using a surgically implantable device has received FDA approval, but its effectiveness in diabetic gastroparesis is not well established 1
- Tight glucose control is essential for patients with diabetes, as hyperglycemia can worsen gastroparesis symptoms 1
From the FDA Drug Label
For the Relief of Symptoms Associated with Diabetic Gastroparesis (Diabetic Gastric Stasis) If only the earliest manifestations of diabetic gastric stasis are present, oral administration of metoclopramide may be initiated. However, if severe symptoms are present, therapy should begin with metoclopramide injection (IM or IV) Metoclopramide is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis.
The treatment for gastroparesis is metoclopramide, which can be administered orally or through injection (IM or IV), depending on the severity of symptoms 2 2.
- Oral administration may be initiated for early manifestations of diabetic gastric stasis.
- Injection therapy should be started for severe symptoms. It is essential to assess the risks and benefits before prescribing metoclopramide treatment.
From the Research
Treatment Options for Gastroparesis
The treatment for gastroparesis involves a multifaceted approach, including:
- Nutritional support to correct fluid, electrolyte, and nutritional deficiencies 3
- Identifying and treating the underlying cause of delayed gastric emptying, such as diabetes mellitus 3
- Pharmacological agents, including prokinetic and antiemetic agents, to suppress or eliminate symptoms 4, 5
- Emerging interventions directed at the pylorus, such as gastric peroral endoscopic myotomy 6, 7
Pharmacological Management
Pharmacological management of gastroparesis includes:
- Prokinetic agents, such as metoclopramide and domperidone, which are the cornerstone of treatment 5
- Antiemetic agents, such as promethazine and ondansetron, to reduce nausea and vomiting 5
- Novel pharmacologic agents, such as prucalopride, relamorelin, and acotiamide, which show promise in treating gastroparesis 6
Procedures and Interventions
Procedures and interventions for gastroparesis include:
- Endoscopic pyloromyotomy, which appears promising in reducing symptoms of nausea and vomiting 6
- Gastric peroral endoscopic myotomy, which requires further evaluation through robust sham-controlled trials to determine its long-term efficacy 7
Multidisciplinary Approach
A multidisciplinary approach with individualized strategies based on characterization of the pathophysiology is necessary to enhance clinical outcomes in patients with gastroparesis 7