What are the treatment options for gastroparesis?

From the Guidelines

Treatment options for gastroparesis are limited, but may include medications to manage symptoms, accelerate gastric emptying, and other interventions.

Medications for Symptom Management

• Medications for nausea and vomiting, such as ondansetron (4-8 mg bid or tid) and metoclopramide (5-20 mg tid-qid), are commonly used to manage symptoms of gastroparesis 1.
• Tricyclic antidepressants, such as amitriptyline (25-100 mg/day), may also be used to manage visceral pain and other symptoms 1.

Medications to Accelerate Gastric Emptying

• Metoclopramide is the only FDA-approved medication for gastroparesis, but its use is limited due to potential side effects and weak evidence supporting its benefits 1.
• Domperidone and erythromycin may also be used to accelerate gastric emptying, but their use is limited due to potential side effects and variable efficacy 1.

Other Interventions

• Gastric electrical stimulation using a surgically implantable device has received FDA approval, but its efficacy is variable and use is limited to individuals with severe symptoms that are refractory to other treatments 1.
• Gastric per-oral endoscopic myotomy (G-POEM) is a newer treatment option that has shown promise in managing symptoms of gastroparesis, but more research is needed to fully understand its benefits and risks 1.
• Dietary adjustments, such as a low-fiber, low-fat eating plan with small frequent meals, may also be helpful in managing symptoms of gastroparesis 1.
• Cognitive and behavioral therapy, hypnotherapy may also be beneficial in managing symptoms of gastroparesis 1.

From the Research

Treatment Options for Gastroparesis

The treatment options for gastroparesis can be broadly categorized into the following:

• Dietary modifications: Frequent and small semisolid-based meals are encouraged to help manage symptoms 2
• Pharmacological agents:
  • Prokinetic agents (erythromycin, domperidone, metoclopramide) to enhance gastric emptying 3, 2
  • Antiemetics (phenothiazines, serotonin antagonists, butyrophenones) to alleviate nausea and vomiting 3
  • 5-HT4 serotonin receptor agonists and dopamine D2 receptor antagonists as novel agents 3
• Invasive options:
  • Intrapyloric botulinum toxin injections to improve gastric emptying 3, 2
  • Placement of a jejunostomy tube for nutritional support 2
  • Implantation of a gastric stimulator to alleviate symptoms 3, 2
• Emerging treatment options:
  • Hemin therapy 2
  • Gastric electric stimulation (low and high-frequency stimulation) to alleviate symptoms 3, 2
  • Regenerative medicine and stem cell-based therapies 2

Management of Gastroparesis

The management of gastroparesis involves:

• Correcting fluid, electrolyte, and nutritional deficiencies 4
• Identifying and treating the underlying cause of delayed gastric emptying (e.g., diabetes mellitus) 4
• Suppressing or eliminating symptoms with pharmacological agents as first-line therapies 4