What is the treatment for gastroparesis?

From the Guidelines

Treatment of gastroparesis involves a comprehensive approach targeting symptom relief and addressing underlying causes, with dietary modifications and medications such as metoclopramide being first-line therapy. Initial management focuses on dietary modifications including small, frequent meals low in fat and fiber, along with adequate hydration, as recommended by the most recent guidelines 1. Medications are central to treatment, with metoclopramide being the only FDA-approved medication for gastroparesis, although its use is recommended for no more than 12 weeks due to the risk of serious adverse effects 1.

Key Components of Treatment

• Dietary modifications: small, frequent meals low in fat and fiber, along with adequate hydration
• Medications: metoclopramide (5-20 mg tid-qid) as first-line therapy, with alternative prokinetics including domperidone and erythromycin
• Antiemetics: such as ondansetron (4-8 mg bid or tid) or promethazine (12.5-25 mg tid or qid) to control nausea and vomiting
• Treatment of underlying conditions: such as diabetes, with maintaining glucose levels below 180 mg/dL being essential

Refractory Cases

For refractory cases, more invasive options may be considered, including gastric electrical stimulation, pyloromyotomy, or gastric bypass, as outlined in the AGA clinical practice update on management of medically refractory gastroparesis 1. Nutritional support through enteral feeding may be necessary in severe cases.

Recent Guidelines

The most recent guidelines from 2024 recommend a low-fiber, low-fat eating plan provided in small frequent meals with a greater proportion of liquid calories, and withdrawing drugs with adverse effects on gastrointestinal motility, including opioids, anticholinergics, TCAs, GLP-1 RAs, and pramlintide 1. The AGA clinical practice update from 2022 also provides guidance on treatment options for refractory gastroparesis symptoms, including medications to accelerate gastric emptying and control nausea and vomiting 1.

From the FDA Drug Label

Metoclopramide is indicated for the relief of symptoms associated with acute and recurrent diabetic gastric stasis. 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)

The treatment for gastroparesis is metoclopramide, which can be administered orally or through injection (IM or IV), depending on the severity of symptoms.

• Oral administration may be initiated for mild symptoms.
• Injection (IM or IV) is recommended for severe symptoms. 2 2

From the Research

Treatment Options for Gastroparesis

The treatment for gastroparesis typically involves a combination of dietary modifications, medication, and other interventions. The goals of treatment are to manage symptoms, correct nutritional deficiencies, and improve gastric emptying 3, 4.

• Dietary Modifications: Patients with gastroparesis are often advised to make dietary changes, such as eating smaller, more frequent meals, and avoiding foods high in fat and fiber 3, 4.
• Medications: Prokinetic agents, such as metoclopramide, and antiemetic agents are commonly used to manage symptoms of gastroparesis 3, 4, 5. Other medications, such as domperidone, erythromycin, and azithromycin, may also be used off-label to treat gastroparesis 3, 6.
• Gastric Electrical Stimulation: This treatment involves the use of a device that delivers electrical impulses to the stomach to help improve gastric emptying and reduce symptoms 3, 4, 7.
• Jejunostomy Tube Feedings: In some cases, patients with severe gastroparesis may require jejunostomy tube feedings to ensure adequate nutrition 3, 4.
• Surgical Interventions: Surgical procedures, such as partial gastrectomy and pyloroplasty, may be considered in rare cases where other treatments have failed 3.

Refractory Symptoms

For patients with refractory symptoms, other treatment options may be considered, including:

• Intrapyloric Botulinum Toxin Injection: This treatment involves injecting botulinum toxin into the pylorus to help relax the muscle and improve gastric emptying 7.
• Endoscopic Pyloromyotomy: This is a minimally invasive procedure that involves making a cut in the pylorus to help improve gastric emptying 7.
• Gastric Electric Stimulation: This treatment may be effective in reducing symptoms of nausea and vomiting in patients with refractory gastroparesis 7.