Do stimulant laxatives help manage symptoms in patients with gastroparesis?

From the Guidelines

Stimulant laxatives are not recommended for managing symptoms in patients with gastroparesis, as they do not address the underlying issue of delayed gastric emptying and may worsen overall symptoms. Gastroparesis is a condition characterized by delayed gastric emptying, primarily affecting the stomach, while stimulant laxatives like bisacodyl (Dulcolax) and senna (Senokot) work on the colon to increase intestinal motility 1. The most recent and highest quality study, published in 2024, suggests that treatment for diabetic gastroparesis may involve a low-fiber, low-fat eating plan, small frequent meals, and withdrawing drugs with adverse effects on gastrointestinal motility 1.

Instead of stimulant laxatives, prokinetic agents that specifically target upper gastrointestinal motility, such as metoclopramide (10mg before meals and at bedtime), erythromycin (50-100mg before meals), or domperidone (where available), are more appropriate for gastroparesis management 1. The use of metoclopramide is recommended for severe cases that are unresponsive to other therapies, but its use beyond 12 weeks is no longer recommended by the FDA due to the risk of serious adverse effects 1. Other treatment options include domperidone (available outside the U.S.) and erythromycin, which is only effective for short-term use due to tachyphylaxis 1.

If a gastroparesis patient is experiencing constipation as a secondary issue, osmotic laxatives like polyethylene glycol might be more appropriate than stimulants, but this should be discussed with a healthcare provider who can address the patient's complete symptom profile and medication regimen. Key considerations in managing gastroparesis include:

• Withdrawing drugs with adverse effects on gastrointestinal motility
• Using prokinetic agents to target upper gastrointestinal motility
• Considering alternative treatments, such as gastric electrical stimulation, for severe cases
• Addressing secondary issues, such as constipation, with appropriate medications and lifestyle changes 1.

From the Research

Gastroparesis and Stimulant Laxatives

• There is no direct evidence in the provided studies that stimulant laxatives help manage symptoms in patients with gastroparesis 2, 3, 4, 5, 6.
• The management of gastroparesis typically involves assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying, and in diabetics, glycemic control 2.
• Medical treatment for gastroparesis entails the use of prokinetic and antiemetic therapies, with metoclopramide being the only FDA-approved medication for gastroparesis 3.
• Other medications aimed at symptom relief include unapproved medications or off-label indications, such as domperidone, erythromycin, and centrally acting antidepressants used as symptom modulators 2.
• Stimulant laxatives are not mentioned as a treatment option for gastroparesis in the provided studies, suggesting that they may not be a recommended or effective treatment for this condition.

Treatment Options for Gastroparesis

• Dietary modification, medications to accelerate gastric emptying, antiemetic agents, gastric electrical stimulation, and surgery are among the treatment options for gastroparesis 6.
• Identifying and treating the cause of delayed gastric emptying, such as diabetes mellitus, is also an important aspect of managing gastroparesis 4.
• Novel pharmacologic agents and interventions are currently being developed to help tailor individualized therapy for patients with gastroparesis 4.

Severity of Delayed Gastric Emptying

• The severity of delayed gastric emptying can impact patient characteristics, treatment responsiveness, and medication adverse events 5.
• Severe delay in gastric emptying is a risk factor for increased hospitalizations and ED visits, and opiate use correlates with increased severity of gastric emptying 5.