From the Guidelines
The initial approach to diagnosing and treating gastroparesis should involve a comprehensive evaluation followed by dietary modifications, including a low-fiber, low-fat eating plan provided in small frequent meals with a greater proportion of liquid calories, as this has been shown to be useful in managing symptoms 1. When evaluating gastroparesis, it is essential to consider the potential impact of medications on gastrointestinal motility.
- Withdrawing drugs with adverse effects on gastrointestinal motility, including opioids, anticholinergics, TCAs, GLP-1 RAs, and pramlintide, may also improve intestinal motility 1.
- The use of prokinetic agents, such as metoclopramide, should be reserved for severe cases that are unresponsive to other therapies due to the risk of serious adverse effects 1. Key considerations in the treatment of gastroparesis include:
- Dietary modifications to manage symptoms
- Avoiding medications that can worsen gastrointestinal motility
- Using prokinetic agents judiciously due to potential side effects
- Considering alternative treatment options, such as domperidone or erythromycin, although their effectiveness may be limited by factors like availability and tachyphylaxis 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 initial approach for diagnosing and treating gastroparesis is not fully described in the label, but for the relief of symptoms associated with diabetic gastroparesis, oral administration of metoclopramide may be initiated if only the earliest manifestations are present.
- However, if severe symptoms are present, therapy should begin with metoclopramide injection (IM or IV) 2.
- Diagnosis is not directly addressed in the label.
- The label provides information on the treatment of gastroparesis but does not provide a comprehensive approach to evaluation.
From the Research
Gastroparesis Evaluation
The initial approach for diagnosing and treating gastroparesis involves several steps:
- Diagnosing gastroparesis using a radioisotope-labeled solid meal with scintigraphic imaging for at least 2 hours, and preferably 4 hours, postprandially 3
- Identifying the underlying cause of gastroparesis, which can be diabetic, postsurgical, idiopathic, or other causes 3, 4, 5, 6, 7
- Controlling symptoms and maintaining adequate nutrition and hydration 3, 4, 6, 7
Treatment Options
Treatment options for gastroparesis include:
- Dietary modifications, such as eating small meals and limiting fat and fiber intake 3, 7
- Medications, such as metoclopramide, prochlorperazine, and ondansetron, to control symptoms 3, 4, 6
- Prokinetic agents, such as erythromycin and tegaserod, to improve gastric emptying 3, 4, 6
- Antiemetic agents, such as phenothiazines and serotonin antagonists, to control nausea and vomiting 4, 6
- Novel treatments, such as gastric electrical stimulation, botulinum toxin injection, and endoscopic pyloromyotomy, for refractory symptoms 4, 5, 7
Diagnostic Tests
Diagnostic tests for gastroparesis include: