From the Guidelines
Treatment options for gastroparesis should prioritize dietary modifications and medications, with a focus on improving gastric emptying and managing symptoms, as recommended by the most recent guidelines 1. The primary approach to managing gastroparesis involves dietary changes, including eating small, frequent meals (4-6 per day) that are low in fat and fiber, with adequate hydration.
- Medications commonly prescribed for gastroparesis include prokinetics such as metoclopramide (5-20 mg tid-qid) or domperidone, which help improve gastric emptying.
- Antiemetics like ondansetron (4-8 mg bid or tid) or promethazine (5-10 mg qid) can manage nausea and vomiting.
- For pain control, low-dose tricyclic antidepressants such as amitriptyline (25-100 mg/day) may be beneficial. In cases unresponsive to these treatments, more invasive options may be considered, including gastric electrical stimulation (Enterra therapy), pyloroplasty, or gastric bypass, as well as emerging treatments like gastric peroral endoscopic myotomy (G-POEM) 1. It is essential to note that the effectiveness of these treatments can vary among individuals, and a stepwise approach starting with conservative measures before progressing to more invasive options typically yields the best outcomes, with consideration of the patient's overall clinical picture and not solely determined by gastric emptying scan results or symptom scores 1.
From the FDA Drug Label
For the Relief of Symptoms Associated With Diabetic Gastroparesis (Diabetic Gastric Stasis) Administer 10 mg of metoclopramide 30 minutes before each meal and at bedtime for two to eight weeks, depending upon response and the likelihood of continued well-being upon drug discontinuation.
The treatment option for gastroparesis is metoclopramide administered at a dose of 10 mg, 30 minutes before each meal and at bedtime, for a duration of 2 to 8 weeks 2.
- The dosage may vary depending on the response and likelihood of continued well-being upon drug discontinuation.
- Severe symptoms may require initial administration of metoclopramide injection for up to 10 days before switching to oral administration.
From the Research
Treatment Options for Gastroparesis
The treatment options for gastroparesis can be categorized into several areas, including dietary modifications, medical therapy, and surgical interventions.
- Dietary Modifications: Dietary changes play a key role in managing gastroparesis, with recommendations including eating frequent small meals, avoiding high fiber and fat-containing foods, and considering oral dietary modifications or enteral nutrition via jejunostomy tube if necessary 3, 4, 5.
- Medical Therapy: Medical treatment entails the use of prokinetic and antiemetic therapies, with current approved treatment options including metoclopramide and gastric electrical stimulation (GES) 3. Other medications aimed at symptom relief include domperidone, erythromycin, and centrally acting antidepressants used as symptom modulators 3, 6.
- Surgical Interventions: Surgical options, such as venting gastrostomy or feeding jejunostomy, may be considered in severe cases, while partial gastrectomy and pyloroplasty should be used rarely, only in carefully selected patients 3, 6.
- Experimental Therapies: Experimental treatments, including intra-pyloric botulinum injections (IPBIs) and gastric peroral endoscopic myotomy (G-POEM), are being researched, with conflicting data regarding their efficacy 7.
Symptomatic Relief
Symptomatic relief is a primary goal in the management of gastroparesis, with treatments aimed at relieving nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain.
- AntiEmetics: Antiemetics may relieve nausea and vomiting, although they have not been specifically tested in gastroparesis 3.
- Prokinetics: Prokinetic agents, such as metoclopramide and domperidone, are used to improve gastric emptying and relieve symptoms 3, 6.
- Gastric Electrical Stimulation (GES): GES may relieve symptoms, including weekly vomiting frequency, and the need for nutritional supplementation, based on open-label studies 3.