From the Guidelines
Treatment for gastroparesis should prioritize dietary modifications and medications, with metoclopramide being the only FDA-approved medication, but its use should be limited to 12 weeks due to the risk of serious adverse effects 1. The primary goal of treatment is to manage symptoms, improve gastric emptying, and enhance quality of life.
- Dietary changes are essential and include eating smaller, more frequent meals (5-6 per day), reducing fat and fiber intake, and avoiding carbonated beverages.
- Medications commonly prescribed include prokinetic agents like metoclopramide (10mg, 30 minutes before meals and at bedtime) which increases stomach contractions, though it should be limited to 12 weeks due to risk of tardive dyskinesia 1.
- Erythromycin (250mg, 2-3 times daily before meals) stimulates motilin receptors to enhance gastric emptying but may lose effectiveness over time due to tachyphylaxis 1.
- Anti-emetics such as ondansetron (4-8mg every 8 hours as needed) can help control nausea and vomiting 1. In treatment-resistant cases, more invasive options include gastric electrical stimulation (Enterra therapy), pyloroplasty, or gastric bypass, and botulinum toxin injections into the pylorus may provide temporary relief for some patients 1. It is crucial to individualize treatment based on symptom severity, underlying causes, and patient response to therapies, while prioritizing the patient's quality of life and minimizing the risk of adverse effects 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)
- 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.
From the Research
Treatment Options for Gastroparesis
The treatment options for gastroparesis can be categorized into several approaches, including dietary changes, medical therapy, and surgical interventions.
- Dietary Changes: Nutritional support is essential in treating patients with gastroparesis 3. Patients should be encouraged to eat frequent small meals with liquid supplementation and reduce extra fat and bulk in their diet.
- Medical Therapy: Medical therapy is usually necessary early in treatment 3. The initial agent of choice is cisapride, which may be combined with an antiemetic agent. If cisapride is ineffective or contraindicated, metoclopramide is a reasonable option 3, 4. Erythromycin is useful in the acute treatment of postoperative ileus and hospitalized gastroparetic patients 3, 4.
- Combination Therapy: Combination therapy should be considered if monotherapy with cisapride or metoclopramide alone is ineffective 3. Combinations include metoclopramide with erythromycin, domperidone with cisapride, and domperidone with erythromycin.
- Surgical Interventions: Invasive treatment should be considered for patients who have persistent unacceptable symptoms and keep losing weight despite drug treatment 4. Options include insertion of a jejunal tube, antrectomy with Billroth-I reconstruction, and subtotal gastrectomy with Roux-Y reconstruction.
- Other Interventions: Other interventions, such as gastric electrical stimulation and endoscopic botolinium toxin injection, may be beneficial for some patients 5. Non-pharmacological interventions, such as hygienic-dietary measures, and endoscopic interventions are also part of the management approach 6.