From the Guidelines
Gastroparesis diagnosis and treatment should prioritize a low-fiber, low-fat eating plan, and medications such as metoclopramide or domperidone to improve gastric motility, with consideration of the potential risks and benefits of each treatment option, as recommended by the most recent guidelines 1.
Diagnostic Approach
The diagnostic process for gastroparesis typically includes:
- Upper endoscopy to exclude mechanical obstruction
- Gastric emptying studies (usually scintigraphy) to measure how quickly food leaves the stomach
Treatment Approach
Treatment begins with dietary modifications, including:
- Eating smaller, more frequent meals
- Reducing fat and fiber intake
- Avoiding foods that slow gastric emptying Medications are often necessary, with first-line options including:
- Metoclopramide (10mg before meals and at bedtime) or domperidone (10mg before meals) to improve gastric motility
- Antiemetics such as ondansetron (4-8mg every 8 hours as needed) to manage nausea For patients with inadequate response, second-line treatments include:
- Erythromycin (50-100mg before meals), which stimulates motilin receptors
- Prucalopride (2mg daily) Refractory cases may benefit from:
- Pyloric botulinum toxin injections
- Gastric electrical stimulation
- Surgical interventions like pyloroplasty Blood glucose control is essential for diabetic patients with gastroparesis, as hyperglycemia can worsen gastric emptying, as noted in recent studies 1.
Personalized Approach
Treatment effectiveness varies significantly between patients, often requiring a personalized approach with combination therapies and regular follow-up to adjust management strategies based on symptom response, as emphasized in the latest clinical practice updates 1.
From the FDA Drug Label
Metoclopramide is a prescription medicine used to: • relieve symptoms of slow stomach emptying in people with diabetes Gastroparesis (gastric stasis) may be responsible for poor diabetic control in some patients.
Gastroparesis Diagnosis and Treatment:
- Diagnosis: The provided drug labels do not directly address the diagnosis of gastroparesis.
- Treatment: Metoclopramide is used to relieve symptoms of slow stomach emptying in people with diabetes, which is a characteristic of gastroparesis 2. It is essential to note that metoclopramide should not be taken for more than 12 weeks to minimize the risk of developing tardive dyskinesia (TD) 2.
From the Research
Gastroparesis Diagnosis
- Gastroparesis is identified in clinical practice through the recognition of clinical symptoms and documentation of delayed gastric emptying 3
- The diagnosis requires documented delay in gastric emptying with an optimal test such as scintigraphy or stable isotope gastric emptying breath test in the absence of mechanical obstruction 4
- Characteristic symptoms of gastroparesis include nausea, vomiting, epigastric pain, early satiety, and weight loss 5
Gastroparesis Treatment
- Management of gastroparesis should include assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying and, in diabetics, glycemic control 3
- Patient nutritional state should be managed by oral dietary modifications, and if oral intake is not adequate, then enteral nutrition via jejunostomy tube needs to be considered 3
- Medical treatment entails use of prokinetic and antiemetic therapies, with metoclopramide being the only FDA approved medication to treat gastroparesis 3, 6
- Other medications aimed at symptom relief include unapproved medications or off-label indications, such as domperidone, erythromycin, and centrally acting antidepressants used as symptom modulators 3, 7
- Gastric electrical stimulation (GES) may relieve symptoms, including weekly vomiting frequency, and the need for nutritional supplementation, based on open-label studies 3
Treatment Options
- Dietary modification, medications to accelerate gastric emptying, antiemetic agents, gastric electrical stimulation, and surgery are available treatment options for gastroparesis 5
- Erythromycin, mimicking the potent gastrokinetic effect of motilin, may hold considerable promise for the future 7
- A multidisciplinary approach with individualized strategies based on characterization of the patho-physiology is deemed necessary to enhance clinical outcomes 4