From the Guidelines
New treatment options for gastroparesis include medications and procedures that have shown promise in recent years, with a focus on enhancing gastric motility, reducing symptoms, and addressing pyloric dysfunction. The most recent and highest quality study, 1, provides best practice advice for managing medically refractory gastroparesis, including reviewing symptoms, verifying gastric emptying study methodology, classifying patients based on symptoms and study results, and identifying the predominant symptom to initiate treatment. Some key treatment options include:
- Medications to accelerate gastric emptying, such as metoclopramide (5-20 mg tid-qid) and domperidone (available through special access programs, 10mg three times daily) 1
- Medications for nausea and vomiting, such as ondansetron (4-8 mg bid or tid) and granisetron (1 mg bid) 1
- Neuromodulators, such as tricyclic antidepressants (TCAs) and serotonin norepinephrine reuptake inhibitors (SNRIs), to treat abdominal pain 1
- Procedural interventions, such as gastric electrical stimulation (Enterra therapy) and pyloromyotomy procedures like G-POEM (gastric peroral endoscopic myotomy) 1
- Botulinum toxin injection into the pylorus for temporary relief 1 It's essential to consider the individual patient's symptoms and response to treatment when selecting the best course of therapy, as recommended by 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.
- Metoclopramide is a treatment option for gastroparesis, specifically for the relief of symptoms associated with diabetic gastroparesis.
- The treatment can be initiated with oral administration if only the earliest manifestations of diabetic gastric stasis are present.
- However, if severe symptoms are present, therapy should begin with metoclopramide injection (IM or IV) 2
From the Research
New Treatment Options for Gastroparesis
- Relamorelin, a synthetic ghrelin analog, has shown promise in treating diabetic gastroparesis (DG) by reducing core symptoms and accelerating gastric emptying 3.
- Several novel pharmacologic agents and interventions are currently in the pipeline and show promise to help tailor individualized therapy for patients with gastroparesis 4.
- Treatments evolving for gastroparesis include nutritional, pharmaceutical, device, and recent advanced endoscopic and surgical therapies 5.
- Endoscopic therapies such as gastric per-oral endoscopic myotomy, also referred to as per-oral endoscopic pyloromyotomy, have been developed as a promising novel endoscopic therapy for gastroparesis 6.
- Other endoscopic approaches being investigated for gastroparesis include enteral feeding tube placement, intrapyloric botulinum toxin injection, transpyloric stenting, and gastric electrical stimulation 7.
Emerging Therapies
- Relamorelin has been well tolerated and safe in humans without cardiac or neurologic adverse effects, and phase III studies are underway 3.
- Gastric electric stimulation and intra-pyloric interventions like botulinum toxin and endoscopic pyloromyotomy may be used to treat refractory symptoms 5.
- Endoscopic pyloromyotomy has shown potential as a treatment for gastroparesis, with currently published literature providing an overview of the technical aspects and potential next directions for the field 6.
Future Directions
- Understanding the pathophysiology of gastroparesis, relating pathophysiologic abnormalities to specific symptoms, and developing new efficacious pharmacotherapies are priorities for future research in the field of gastroparesis 5.
- Further innovation and development in minimally invasive endoscopic treatments for gastroparesis are expected to provide more effective and durable treatment options for patients 7.