From the Guidelines
Gastroparesis treatment should prioritize dietary modifications and medications, with metoclopramide being the only FDA-approved medication, while considering the risks and benefits of other treatment options, including gastric electrical stimulation and gastric peroral endoscopic myotomy, as supported by the most recent evidence 1.
Causes of Gastroparesis
The most common causes of gastroparesis include:
- Diabetes, especially long-standing, poorly controlled diabetes
- Surgical damage to the vagus nerve
- Certain medications, such as opioid pain relievers, some antidepressants, and certain diabetes medications
- Viral infections
- Neurological disorders, such as Parkinson's disease
- Idiopathic gastroparesis, where the cause remains unknown
Treatment of Gastroparesis
Treatment typically involves:
- Dietary modifications, such as eating smaller, more frequent meals, reducing fat and fiber intake, and avoiding foods that slow gastric emptying
- Medications, including prokinetic agents like metoclopramide (10mg before meals and at bedtime) or erythromycin (250mg before meals), which stimulate stomach contractions, and antiemetics such as ondansetron (4-8mg as needed) to control nausea and vomiting
- In severe cases, procedural interventions, such as botulinum toxin injections into the pylorus, gastric electrical stimulation (gastric pacemaker), or surgical procedures like pyloroplasty, may be considered
- For diabetic patients, blood sugar control is essential, as hyperglycemia can worsen gastroparesis, as noted in the 2024 standards of care in diabetes 1
Recent Developments in Treatment
Recent studies have explored the use of gastric peroral endoscopic myotomy (G-POEM) for medically refractory gastroparesis, with promising results, as discussed in the 2023 AGA clinical practice update on gastric peroral endoscopic myotomy for gastroparesis 1
- G-POEM has been shown to improve symptoms and gastric emptying in patients who have not responded to medical therapy
- However, more research is needed to fully understand the benefits and risks of G-POEM for gastroparesis treatment
Key Considerations
When treating gastroparesis, it is essential to:
- Monitor patients closely for potential side effects of medications, such as metoclopramide, which can cause extrapyramidal symptoms, as noted in the 2024 standards of care in diabetes 1
- Consider the risks and benefits of procedural interventions, such as gastric electrical stimulation and G-POEM, and discuss these with patients and their families
- Prioritize dietary modifications and lifestyle changes to manage symptoms and improve quality of life, as supported by the 2022 AGA clinical practice update on management of medically refractory gastroparesis 1
From the FDA Drug Label
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 causes of gastroparesis are not directly mentioned in the provided drug labels. The treatment for gastroparesis is metoclopramide, which can be administered orally or through injection (IM or IV), depending on the severity of symptoms 2. Key points about the treatment include:
- Oral administration may be initiated for early manifestations of diabetic gastric stasis
- Injection therapy should be started for severe symptoms
- The dosage and administration route may vary depending on the patient's condition and response to treatment 2
From the Research
Gastroparesis Causes
- The exact cause of gastroparesis is often unknown, but it can be associated with diabetes, neurological disorders, and certain medications 3, 4.
- Delayed gastric emptying is a hallmark of gastroparesis, and it can lead to symptoms such as nausea, vomiting, and abdominal pain 4, 5.
Gastroparesis Treatment
- Dietary modifications, such as eating small, frequent meals and avoiding fatty and high-fiber foods, can help manage symptoms 3, 4.
- Medications, including prokinetic agents like metoclopramide and erythromycin, and antiemetics like prochlorperazine, can help relieve symptoms 3, 4, 6.
- Gastric electrical stimulation is a treatment option for patients with refractory gastroparesis, and it has been shown to improve symptoms in some patients 3, 5.
- Other treatment options, including jejunostomy tube placement, intrapyloric botulinum toxin injections, and gastric surgery, may be considered in severe cases 4, 5.
- Novel treatments, such as novel prokinetics, interventions on the pylorus, and new forms of gastric electrical stimulation, are being developed and studied 7.
Treatment Goals
- The primary goals of treatment are to control symptoms, correct nutritional deficiencies, and improve gastric emptying 3, 5.
- Treatment should be individualized based on the severity of symptoms, the underlying cause of gastroparesis, and the patient's response to therapy 3, 5.
Emerging Treatment Options
- Novel medications, such as motilin agonists, 5-HT4 receptor agonists, and ghrelin agonists, are being developed and studied 7.
- Interventions on the pylorus, such as stent placement, endoscopic pyloric myotomy, and laparoscopic pyloroplasty, may offer a more permanent reduction in resistance to flow at the pylorus 7.
- New forms of gastric electrical stimulation, such as per-endoscopic electrical stimulation, are being developed and studied 7.