This summary reviews the discussion regarding recent gastroparesis guidelines: Camilleri M, Kuo B, Nguyen L, et al. ACG Clinical Guideline: Gastroparesis. Am J Gastroenterol 2022;117(8):1197-1220 (podcast series)
- The diagnosis of gastroparesis primarily involves a scintigraphic solid food gastric emptying study lasting at least 3-4 hours. For accurate results, patients need to stop taking pro-motility agents, antiemetics, opioids, marijuana, and neuromodulators for 48 hours before the exam and maintain controlled glucose levels.
- Initial management usually involves a small-particle diet, which includes foods less than 2 mm in diameter or with a mashed potato-like consistency.
- Metoclopramide is the only FDA-approved medication for gastroparesis, showing some effectiveness in relieving symptoms and improving gastric motility, although studies have methodological limitations. The risk of tardive dyskinesia associated with metoclopramide is estimated to be low, at about 0.1% per 1,000 person-years.
For patients experiencing constipation, prucalopride (2 mg twice daily) may be prescribed, as it is the only FDA-approved 5-HT4 agonist available in the U.S. If metoclopramide is deemed appropriate, a thorough discussion regarding the risks and benefits occurs, with a gradual dose increase to 10 mg three times daily, potentially extending beyond the FDA’s recommended 12 weeks for patients showing significant improvement.- Domperidone, known for its pro-motility and anti-emetic effects, is recognized as a potentially more effective treatment option. However, it is only available in the U.S. through an FDA-monitored extended access program, prompting some patients to seek prescriptions from physicians in Canada.
- In terms of antiemetics, ondansetron is avoided due to its possible impact on intestinal motility, while cyproheptadine is favored as an alternative. Patients using opioids for abdominal pain are advised to taper off, as continued use is likely to exacerbate gastroparesis symptoms. Similarly, for chronic marijuana users, it may take up to two months to observe symptom improvement after cessation.
ICYMI: ACG Clinical Guideline on Gastroparesis-Limited Evidence-Based Options