What are the guidelines for treating gastroparesis?

From the Guidelines

Treatment of gastroparesis should prioritize a comprehensive approach, starting with dietary modifications and medications, to improve symptoms and quality of life, as evidenced by the most recent guidelines 1. The management of gastroparesis involves a multifaceted strategy, including dietary changes, pharmacological interventions, and procedural interventions. Patients should adhere to a low-fiber, low-fat diet, consuming small, frequent meals (4-6 daily) to alleviate symptoms.

• Key dietary recommendations include:
  • Eating small, frequent meals
  • Avoiding foods that delay gastric emptying
  • Increasing liquid calorie intake
• First-line medications for gastroparesis include prokinetics such as metoclopramide (5-10mg before meals and at bedtime) for up to 12 weeks, due to the risk of tardive dyskinesia, or domperidone (10-20mg before meals and at bedtime) where available, as supported by recent studies 1.
• Antiemetics like ondansetron (4-8mg every 8 hours as needed) or prochlorperazine (5-10mg every 6 hours) can help manage nausea, as outlined in the AGA clinical practice update 1. In refractory cases, more invasive options, such as gastric electrical stimulation, pyloromyotomy, or feeding tubes (jejunostomy) for nutritional support, may be considered.
• The treatment approach should be individualized based on symptom severity, underlying cause, and comorbidities, with the goal of improving gastric emptying, managing symptoms, and ensuring adequate nutrition when gastric function is severely compromised, as recommended by the most recent guidelines 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. The physician should make a thorough assessment of the risks and benefits prior to prescribing further metoclopramide treatment

Guidelines for Gastroparesis Treatments:

• Diabetic Gastroparesis: Metoclopramide may be initiated orally if early manifestations of diabetic gastric stasis are present.
• Assessment: A thorough assessment of risks and benefits should be made before prescribing metoclopramide treatment 2.
• Key Consideration: The decision to use metoclopramide should be based on a careful evaluation of the potential benefits and risks, particularly in patients with certain medical conditions or taking other medications 2.

From the Research

Gastroparesis Treatment Guidelines

The treatment of gastroparesis involves a multi-faceted approach, including:

• Assessment and correction of nutritional state
• Relief of symptoms
• Improvement of gastric emptying
• Glycemic control in diabetic patients 3 Medical treatment entails the use of prokinetic and antiemetic therapies, with current approved treatment options including metoclopramide and gastric electrical stimulation (GES) 3.

Nutritional Management

Nutritional approaches for gastroparesis include:

• Modification of food composition, consistency, and volume
• Use of liquid meals, oral nutrition supplements, enteral nutrition, and parenteral nutrition if necessary 4
• Management of patient nutritional state through oral dietary modifications, with enteral nutrition via jejunostomy tube considered if oral intake is not adequate 3

Pharmacological Management

Pharmacological treatment options for gastroparesis include:

• Prokinetic agents such as metoclopramide and domperidone
• Antiemetic agents such as promethazine and ondansetron
• Novel pharmacotherapies, although compelling evidence for their efficacy remains to be established 5
• Domperidone, which has been shown to improve symptoms of gastroparesis, including overall gastroparesis symptom severity, early satiety, postprandial fullness, and nausea 6

Potential Drug-Drug Interactions

The treatment of gastroparesis often involves the co-administration of several classes of pharmacological agents, which may lead to potential drug-drug interactions (DDIs) 7.

• Prokinetic agents, antiemetic agents, and antidiabetic agents may be metabolized via common drug metabolizing enzymes, triggering potential DDIs
• Many commonly prescribed combinations have been predicted to cause potential DDIs in gastroparesis patients, highlighting the need for careful consideration of potential interactions 7