What is the initial management for an adult with gastrparesis (gastric paralysis) experiencing uncomplicated enteritis and transit intussusception?

Management of Gastroparesis with Uncomplicated Enteritis and Transit Intussusception

For an adult with gastroparesis experiencing uncomplicated enteritis and transit intussusception, the initial management should focus on symptom control with metoclopramide 10 mg IV administered slowly over 1-2 minutes, followed by oral metoclopramide when symptoms improve, along with dietary modifications including small, frequent, low-fat, low-fiber meals. 1, 2, 3

Initial Assessment and Management

Symptom Control

• Antiemetics and prokinetics:

  • Metoclopramide: Start with 10 mg IV administered slowly over 1-2 minutes for severe symptoms 1
  • Once symptoms begin to subside (typically within 10 days), transition to oral metoclopramide 10 mg three times daily before meals 2, 1
  • Monitor for extrapyramidal side effects and tardive dyskinesia (black box warning) 2

• For persistent nausea/vomiting:

  • Consider adding phenothiazines or serotonin (5-HT3) receptor antagonists as needed 3
  • Erythromycin 40-250 mg orally three times daily may be considered as an alternative prokinetic agent 2, 3

Dietary Management

• Implement small, frequent meals (5-6 per day) 3
• Low-fat, low-fiber diet with increased liquid calories 3
• Avoid carbonated beverages, alcohol, and smoking 3
• Consider liquid diet if symptoms are moderate to severe 2

Management of Transit Intussusception

Transit intussusception in adults is typically transient and self-limiting, requiring different management than the surgical approach often needed for persistent intussusception 4.

• Conservative management is appropriate for uncomplicated transit intussusception:

  • Monitor for resolution with supportive care
  • Avoid unnecessary surgical intervention if no signs of obstruction or perforation
  • Continue prokinetic therapy to improve intestinal motility

• Warning signs requiring escalation of care:

  • Persistent abdominal pain
  • Signs of bowel obstruction
  • Peritoneal signs
  • Hemodynamic instability

Management of Enteritis

For uncomplicated enteritis in the setting of gastroparesis:

• Hydration: Ensure adequate fluid intake, consider IV fluids if oral intake is inadequate
• Electrolyte monitoring: Check and correct any electrolyte abnormalities 2
• Avoid medications that can worsen gastric emptying:
  • Opioids
  • Anticholinergics
  • GLP-1 receptor agonists 3

Escalation of Care

If symptoms persist after 2-4 weeks of initial management:

1. Consider switching prokinetic agents or combination therapy 3
2. For refractory symptoms:
   • Enteral feeding via jejunostomy tube if oral intake remains inadequate 2, 5
   • Gastric electrical stimulation may be considered for severe, refractory cases 3, 5
3. Referral to gastroenterology specialist for further evaluation and management 3

Special Considerations for Diabetic Gastroparesis

If gastroparesis is related to diabetes:

• Optimize glycemic control as hyperglycemia can further delay gastric emptying 3
• Consider DPP-4 inhibitors as they have a neutral effect on gastric emptying 3
• Insulin therapy with carefully titrated regimens may be appropriate 3

Common Pitfalls to Avoid

• Don't delay prokinetic therapy in symptomatic patients with confirmed gastroparesis
• Avoid medications that worsen gastric emptying (opioids, anticholinergics, GLP-1 agonists)
• Don't rush to surgical intervention for transit intussusception without clear evidence of complications
• Avoid prolonged use of metoclopramide (>12 weeks) due to risk of tardive dyskinesia 3
• Don't neglect nutritional status - malnutrition can worsen outcomes in gastroparesis 2, 5

By following this approach, most patients with gastroparesis experiencing uncomplicated enteritis and transit intussusception can be effectively managed with symptom improvement and prevention of complications.