What are the treatment options for gastroparesis?

From the Guidelines

Treatment for gastroparesis should prioritize dietary modifications and medications, with metoclopramide being the only FDA-approved medication, while considering the risks and benefits of each option. The management of gastroparesis is challenging and requires a multifaceted approach. According to the most recent evidence 1, a low-fiber, low-fat eating plan provided in small frequent meals with a greater proportion of liquid calories may be useful. Additionally, withdrawing drugs with adverse effects on gastrointestinal motility, such as opioids, anticholinergics, and GLP-1 RAs, may also improve intestinal motility.

Some key treatment options for gastroparesis include:

• Dietary modifications: small, frequent meals, low-fat and low-fiber foods, and avoiding carbonated beverages
• Medications: metoclopramide (5-10mg before meals and at bedtime), domperidone (10mg before meals and at bedtime), and antiemetics like ondansetron (4-8mg every 8 hours as needed)
• Other interventions: gastric electrical stimulation, botulinum toxin injections into the pylorus, and enteral feeding

It is essential to note that the level of evidence regarding the benefits of metoclopramide for the management of gastroparesis is weak, and its use is recommended only for severe cases that are unresponsive to other therapies 1. Furthermore, the risk of removal of GLP-1 RAs should be balanced against their potential benefits. The most recent study 1 provides a comprehensive overview of treatment options for refractory gastroparesis symptoms, including medications to accelerate gastric emptying and manage visceral pain. However, it is crucial to prioritize the single most recent and highest quality study, which in this case is 1, to ensure the best possible outcome for patients with gastroparesis.

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)

• Treatment options for gastroparesis include oral administration of metoclopramide for mild symptoms and metoclopramide injection (IM or IV) for severe symptoms 2.
• The dosage and administration of metoclopramide may vary depending on the severity of symptoms and the patient's response to treatment.
• Key considerations for treatment include the patient's renal function, as metoclopramide is excreted principally through the kidneys, and the potential for adverse reactions, such as acute dystonic reactions.

From the Research

Treatment Options for Gastroparesis

The treatment of gastroparesis often involves a combination of dietary modifications, medications, and other interventions. Some of the key treatment options include:

• Dietary modifications: Patients with gastroparesis are often advised to eat small, frequent meals, and to avoid fatty or high-fiber foods that can slow down gastric emptying 3.
• Prokinetic agents: Medications such as metoclopramide and domperidone can help to accelerate gastric emptying and relieve symptoms such as nausea and vomiting 4, 5, 6.
• Antiemetic agents: Medications such as promethazine and ondansetron can help to relieve nausea and vomiting in patients with gastroparesis 4, 6.
• Gastric electrical stimulation: This involves the use of a device that delivers electrical impulses to the stomach to help stimulate gastric emptying and relieve symptoms 6, 3.
• Surgery: In some cases, surgery may be necessary to relieve symptoms of gastroparesis, such as gastroparesis-associated nausea and vomiting that is resistant to medical therapy 6.

Medications Used to Treat Gastroparesis

Some of the medications that are commonly used to treat gastroparesis include:

• Metoclopramide: A prokinetic agent that can help to accelerate gastric emptying and relieve symptoms such as nausea and vomiting 4, 5, 6.
• Domperidone: A prokinetic agent that can help to accelerate gastric emptying and relieve symptoms such as nausea and vomiting 4, 5, 6.
• Tegaserod: A selective serotonin type 4 receptor partial agonist that can help to accelerate gastric emptying and relieve symptoms such as nausea and vomiting 7.
• Erythromycin: An antibiotic that can also be used as a prokinetic agent to help accelerate gastric emptying and relieve symptoms such as nausea and vomiting 5, 6.

Other Interventions

Other interventions that may be used to treat gastroparesis include:

• Enteral nutrition: This involves the delivery of nutrients directly into the small intestine, bypassing the stomach, and can be used in patients who are unable to eat or absorb nutrients normally 6.
• Parenteral nutrition: This involves the delivery of nutrients directly into the bloodstream, and can be used in patients who are unable to eat or absorb nutrients normally 6.
• Botulinum toxin injection: This involves the injection of botulinum toxin into the pyloric sphincter to help relax the muscle and improve gastric emptying 6.