What is the best treatment for gastroparesis?

From the Guidelines

The best treatment for gastroparesis is a multi-faceted approach that includes medications to manage symptoms, dietary changes, and procedures such as gastric electrical stimulation or gastric peroral endoscopic myotomy (G-POEM) in severe cases.

Treatment Options

• Medications for nausea and vomiting:
  • Ondansetron (4–8 mg bid or tid) 1
  • Granisetron (1 mg bid) 1
  • Aprepitant (80 mg/day) 1
• Medications to accelerate gastric emptying:
  • Metoclopramide (5–20 mg tid–qid), although its use is limited due to potential side effects and it should be reserved for severe cases that are unresponsive to other therapies 1
  • Domperidone (10 mg tid), available outside the U.S. 1
• Dietary changes: a low-fiber, low-fat eating plan provided in small frequent meals with a greater proportion of liquid calories may be useful 1
• Procedures:
  • Gastric electrical stimulation (GES) may improve refractory nausea and vomiting in some patients with gastroparesis 1
  • G-POEM may be offered to patients with moderate-to-severe symptoms from refractory gastroparesis, particularly those with primarily nausea and vomiting 1

Important Considerations

• The treatment of gastroparesis should be individualized based on the severity of symptoms, the presence of underlying conditions such as diabetes, and the patient's response to initial therapies.
• The use of medications such as metoclopramide and domperidone should be carefully considered due to potential side effects.
• GES and G-POEM are options for patients with severe gastroparesis who have failed other therapies, but their use should be determined on a case-by-case basis.

From the Research

Treatment Options for Gastroparesis

The treatment for gastroparesis typically involves a combination of dietary modifications, medications, and procedures to manage symptoms and improve gastric emptying. Some of the treatment options include:

• Dietary modifications: Oral dietary modifications to manage patient nutritional state 2
• Medications:
  • Prokinetic agents such as metoclopramide, domperidone, and erythromycin to improve gastric emptying 2, 3
  • Antiemetic agents such as aprepitant to relieve nausea and vomiting 4
  • Fundic relaxants such as acotiamide and buspirone to improve gastric accommodation 4
• Procedures:
  • Endoscopic pyloromyotomy to relieve symptoms of nausea and vomiting 4
  • Gastric electrical stimulation (GES) to relieve symptoms such as weekly vomiting frequency and the need for nutritional supplementation 2
  • Enteral access tubes, such as jejunostomy tubes, for patients with severe malnutrition or dehydration 2, 5
  • Gastrectomy, which should be used rarely and only in carefully selected patients 2, 5

Novel Treatment Strategies

Several novel pharmacologic agents and interventions are currently being developed to help tailor individualized therapy for patients with gastroparesis, including:

• Relamorelin, a prokinetic agent 4
• Prucalopride, a prokinetic agent 4
• Endoscopic and surgical interventions, such as pyloric interventions and gastrectomy, which are reserved for refractory cases of gastroparesis 5

Management of Gastroparesis

The management of gastroparesis involves:

• Correcting fluid, electrolyte, and nutritional deficiencies 6
• Identifying and treating the cause of delayed gastric emptying, such as diabetes mellitus 6
• Suppressing or eliminating symptoms with pharmacological agents as first-line therapies 6