Treatment of gastroparesis
- Michael Camilleri, MD
Michael Camilleri, MD
- Professor of Medicine, Pharmacology, and Physiology
- Mayo Clinic College of Medicine
Gastroparesis is a syndrome of objectively delayed gastric emptying in the absence of a mechanical obstruction and cardinal symptoms of nausea, vomiting, early satiety, bloating, and/or upper abdominal pain.
This topic will review the treatment of gastroparesis. The pathophysiology, etiology, and diagnosis of gastroparesis and the management of malignancy-associated gastroparesis are discussed separately. (See "Pathogenesis of delayed gastric emptying" and "Gastroparesis: Etiology, clinical manifestations, and diagnosis" and "Malignancy-associated gastroparesis: Pathophysiology and management".)
Our recommendations are largely consistent with the guidelines issued by the American Gastroenterological Association (AGA) and the American College of Gastroenterology (ACG) [1,2].
Initial management of gastroparesis consists of dietary modification, optimization of glycemic control and hydration, and in patients with continued symptoms, pharmacologic therapy with prokinetic and antiemetics. A suggested approach to the management of gastroparesis based on the extent of delay in gastric emptying is outlined in the algorithm (algorithm 1).
Dietary modification — Dietary modification is considered first line therapy in patients with mild gastroparesis, although in clinical practice it is associated with only a modest improvement in symptoms. Fat slows gastric emptying and nondigestible fiber (eg, fresh fruits and vegetables) require effective interdigestive antral motility that is frequently absent in patients with significantly delayed gastric emptying. Patients with gastroparesis should be advised by a dietician to consume small, frequent meals four to five times a day that are low in fat and contain only soluble fiber. For patients who are unable to tolerate solid food, meals should be homogenized, as gastric emptying of liquids is often normal even when emptying of solids is delayed [2,3]. Patients should also be advised to avoid carbonated beverages as they can aggravate gastric distention . Alcohol and smoking should also be avoided as they can decrease antral contractility and delay gastric emptying [4,5].
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- INITIAL MANAGEMENT
- Dietary modification
- Hydration and nutrition
- Optimize glycemic control
- - Metoclopramide
- - Domperidone
- - Macrolide antibiotics
- - Cisapride
- REFRACTORY SYMPTOMS
- Decompression and feeding
- Tricyclic antidepressants
- Other therapies
- Gastric electrical stimulation
- MANAGEMENT OF ACUTE EXACERBATIONS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS