From the Guidelines
The initial treatment for gastric akinesis (also known as gastroparesis) involves dietary modifications and medications to improve gastric emptying, with a low-fiber, low-fat eating plan provided in small frequent meals being the first-line approach, as recommended by the most recent guidelines 1.
Key Components of Treatment
- Dietary modifications:
- Low-fiber, low-fat diet
- Small, frequent meals
- Greater proportion of liquid calories
- Medications:
- Prokinetic medications, such as metoclopramide, as the first-line pharmacological treatment
- Alternatives include domperidone, erythromycin, and prucalopride
- Avoidance of substances that delay gastric emptying, such as opioids and anticholinergics
Rationale for Treatment Approach
The treatment approach is based on the most recent guidelines, which emphasize the importance of dietary modifications and prokinetic medications in managing gastroparesis 1. Metoclopramide is the most commonly used prokinetic medication, but its use should be limited to 12 weeks or less due to the risk of tardive dyskinesia.
Additional Considerations
- Individualization of treatment based on symptom severity and underlying causes
- Use of antiemetics, such as ondansetron or promethazine, to control nausea and vomiting
- Avoidance of alcohol and smoking, which can exacerbate symptoms By following this treatment approach, patients with gastric akinesis can experience improved symptoms and quality of life, while minimizing the risk of adverse effects.
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 treatment for gastric akinesis, also known as diabetic gastroparesis, is oral administration of metoclopramide if only the earliest manifestations are present 2.
From the Research
Gastric Akinesis Treatment
Gastric akinesis, also known as gastroparesis, is a disorder characterized by delayed gastric emptying in the absence of mechanical obstruction. The initial treatment for gastric akinesis typically involves:
- Symptomatic relief with medication to counteract nausea, emesis, pain, bloating, gastroesophageal reflux, and early satiety 3
- Dietary modification, including small meals and avoidance of high fiber and fat-containing foods 3, 4
- Medical therapy, usually necessary early in treatment, with cisapride as the initial agent of choice, which may be combined with an antiemetic agent 4
- Enteral feeding, introduced in the event of weight loss or persistent vomiting 4
Treatment Options
Other treatment options for gastric akinesis include:
- Metoclopramide, a reasonable option if cisapride is ineffective or contraindicated, though limited by side effects 4
- Erythromycin, useful in the acute treatment of postoperative ileus and hospitalized gastroparetic patients, but its role is limited based on concerns about poor long-term effectiveness and antimicrobial resistance 4, 5, 6
- Combination therapy, which should be considered if monotherapy with cisapride or metoclopramide alone is ineffective 4
- Gastric pacing, which may become an effective option for patients not responding to medical therapy 4
- Total gastrectomy, which should be performed only for end-stage gastroparesis when all other therapy has failed 4
Effectiveness of Treatment Options
Studies have shown that:
- Erythromycin is more effective than metoclopramide in treating feed intolerance in critical illness 5
- Erythromycin reduces delayed gastric emptying in critically ill trauma patients 6
- Bedside nasointestinal tube placement using the Cortrak system can increase enteral nutrition delivery and reduce cumulative feeding days lost and prokinetic use 7