Current Treatment Options in Gastroenterology

, Volume 10, Issue 4, pp 283–293 | Cite as

Advances in the management of gastroparesis

Article

Opinion statement

The treatment goals for patients with gastroparesis are to control symptoms; to correct fluid, electrolyte, and nutritional deficiencies; and to identify and treat the underlying cause of gastroparesis. For mild symptoms, dietary modifications and a low-dose antiemetic and/or prokinetic agent might provide satisfactory control of symptoms. Dietary treatments include decreasing the solid food component while increasing the liquid nutrient component of meals. Fat and fiber intake should be minimized. Metoclopramide, despite its potential for neurological side effects, remains a prokinetic treatment for symptomatic patients. In patients with diabetic gastroparesis, careful regulation of glycemic control may help to reduce symptoms. Medical management of patients with gastroparesis who do not respond to initial antiemetic or prokinetic therapy or who develop medication-related side effects involves the use of other prokinetic and antiemetic agents with different mechanisms of action. Combinations of prokinetic and antiemetic agents often are tried in patients with persistent symptoms. In some patients with persistent refractory symptoms and failure to maintain adequate fluid and/or nutritional intake, bypassing the stomach with jejunostomy feedings may be necessary. Gastric electrical stimulation is a treatment for refractory gastroparesis. Based on initial studies showing symptom benefit, especially in patients with diabetic gastroparesis, gastric electrical stimulation was granted humanitarian US Food and Drug Administration approval for the treatment of chronic, refractory nausea and vomiting secondary to idiopathic or diabetic gastroparesis. However, which patients are likely to respond, the optimal electrode position, and the optimal stimulation parameters remain areas that need to be addressed.

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References and Recommended Reading

  1. 1.
    He CL, Soffer EE, Ferris CD, et al.: Loss of interstitial cells of cajal and inhibitory innervation in insulin-dependent diabetes. Gastroenterology 2001, 121:427–434.PubMedCrossRefGoogle Scholar
  2. 2.
    Sarnelli G, Caenepeel P, Geypens B, et al.: Symptoms associated with impaired gastric emptying of solids and liquids in functional dyspepsia Am J Gastroenterol 2003, 98:783–788.PubMedCrossRefGoogle Scholar
  3. 3.
    Lemann M, Dederding JP, Flourie B, et al.: Abnormal perception of visceral pain in response to gastric distension in chronic idiopathic dyspepsia. Dig Dis Sci 1991, 36:1249–1254.PubMedCrossRefGoogle Scholar
  4. 4.
    Parkman HP, Harris AD, Krevsky B, et al.: Gastroduodenal motility and dysmotility: update on techniques available for evaluation Am J Gastroenterol 1995, 90:869–892.PubMedGoogle Scholar
  5. 5.
    Thomforde GM, Camilleri M, Phillips SF, Forstrom LA: Evaluation of an inexpensive screening scintigraphic test of gastric emptying. J Nucl Med 1995, 36:93–96.PubMedGoogle Scholar
  6. 6.
    Guo JP, Maurer AH, Fisher RS, Parkman HP: Extending gastric emptying scintigraphy from two to four hours detects more patients with gastroparesis. Dig Dis Sci 2001, 46:24–29.PubMedCrossRefGoogle Scholar
  7. 7.
    Tougas G, Eaker EY, Abell TL, et al.: Assessment of gastric emptying using a low fat meal: establishment of international control values. Am J Gastroenterol 2000, 95:1456–1462.PubMedCrossRefGoogle Scholar
  8. 8.
    Kuo B, McCallum RW, Koch KL, et al.: SmartPill, a novel ambulatory diagnostic test for measuring gastric emptying in health and disease [abstract]. Gastroenterology 2006, 130(4 Suppl 1):A434.Google Scholar
  9. 9.
    Bromer MQ, Kantor SN, Wagner DA, et al.: Simultaneous measurement of gastric emptying with a simple muffin meal using 13C-octanocate breath test and scintigraphy in normal subjects and patients with in dyspeptic symptoms. Dig Dis Sci 2002, 47:1657–1663.PubMedCrossRefGoogle Scholar
  10. 10.
    Fontana RJ, Barnett JL: Jejunostomy tube placement in refractory diabetic gastroparesis: a retrospective review. Am J Gastroenterol 1996, 91:2174–2178.PubMedGoogle Scholar
  11. 11.
    Friedenberg F, Parkman HP: Management of delayed gastric emptying. Clin Gastroenterol Hepatol 2005, 3:642–646.PubMedCrossRefGoogle Scholar
  12. 12.
    Rayner CK, Samsom M, Jones KL, Horowitz M: Relationships of upper gastrointestinal motor and sensory function with glycemic control. Diabetes Care 2001, 24:371–381.PubMedCrossRefGoogle Scholar
  13. 13.
    Fraser RJ, Horowitz M, Maddox AF, et al.: Hyperglycaemia slows gastric emptying in type 1 (insulin-dependent) diabetes mellitus. Diabetologia 1990, 33:675–680.PubMedCrossRefGoogle Scholar
  14. 14.
    Brownlee M, Kroopf SS: Metoclopramide for gastroparesis diabeticorum. N Engl J Med 1974, 291:1257–1258.PubMedGoogle Scholar
  15. 15.
    McCallum RW, Ricci DA, Rakatansky H, et al.: A multicenter placebo-controlled clinical trial of oral metoclopramide in diabetic gastroparesis. Diabetes Care 1983, 6:463–467.PubMedCrossRefGoogle Scholar
  16. 16.
    Ganzini L, Casey DE, Hoffman WF, McCall AL: The prevalence of metoclopramide-induced tardive dyskinesia and acute extrapyramidal movement disorders. Arch Intern Med 1993, 153:1469–1475.PubMedCrossRefGoogle Scholar
  17. 17.
    Miller LG, Jankovic J: Metoclopramide-induced movement disorders. Clinical findings with a review of the literature. Arch Intern Med 1989, 149:2486–2492.PubMedCrossRefGoogle Scholar
  18. 18.
    Patterson D, Abell T, Rothstein R, et al.: A double-blind multicenter comparison of domperidone and metoclopramide in the treatment of diabetic patients with symptoms of gastroparesis. Am J Gastroenterol 1999, 94:1230–1234.PubMedGoogle Scholar
  19. 19.
    Watts GF, Armitage M, Sinclair J, Hill JD: Treatment of diabetic gastroparesis with oral domperidone. Diabet Med 1985, 2:491–492.PubMedCrossRefGoogle Scholar
  20. 20.
    DiBaise JK, Quigley EM: Efficacy of prolonged administration of intravenous erythromycin in an ambulatory setting as treatment of severe gastroparesis. J Clin Gastroenterol 1999, 28:131–134.PubMedCrossRefGoogle Scholar
  21. 21.
    Maganti K, Onyemere K, Jones MP: Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol 2003, 98:259–263.PubMedGoogle Scholar
  22. 22.
    Erbas T, Varoglu E, Erbas B, et al.: Comparison of metoclopramide and erythromycin in the treatment of diabetic gastroparesis. Diabetes Care 1993, 16:1511–1514.PubMedCrossRefGoogle Scholar
  23. 23.
    Di Stefano M, Vos R, Janssens J, Tack JF: Effect of tegaserod, a 5-HT4 receptor partial agonist, on interdigestive and postprandial gastrointestinal motility in healthy volunteers [abstract]. Gastroenterology 2003, 124:A163.CrossRefGoogle Scholar
  24. 24.
    Degen L, Matzinger D, Merz M, et al.: Tegaserod, a 5-HT4 receptor partial agonist, accelerates gastric emptying and gastrointestinal transit in healthy male subjects Aliment Pharmacol Ther 2001, 15:1745–1751.PubMedCrossRefGoogle Scholar
  25. 25.
    Tougas G, Chen Y, Luo D, et al.: Tegaserod improves gastric emptying in patients with gastroparesis and dyspeptic symptoms [abstract]. Gastroenterology 2003, 124:A54–A68.CrossRefGoogle Scholar
  26. 26.
    Bromer MQ, Friedenberg F, Miller LS, et al.: Endoscopic pyloric injection of botulinum toxin A for the treatment of refractory gastroparesis. Gastrointest Endosc 2005, 61:833–839.PubMedCrossRefGoogle Scholar
  27. 27.
    Miller LS, Szych GA, Kantor SB, et al.: Treatment of idiopathic gastroparesis with injection of botulinum toxin into the pyloric sphincter muscle. Am J Gastroenterol 2002, 97:1653–1660.PubMedCrossRefGoogle Scholar
  28. 28.
    Friedenberg F, Gollamudi S, Parkman HP: Review: the use of botulinum toxin for the treatment of gastrointestinal motility disorders. Dig Dis Sci 2004, 2:165–175.CrossRefGoogle Scholar
  29. 29.
    Hotokezaka M, Adams RB, Miller AD, et al.: Laparoscopic percutaneous jejunostomy for long term enteral access. Surg Endosc 1996, 10:1008–1011.PubMedCrossRefGoogle Scholar
  30. 30.
    Abell T, McCallum R, Hocking M, et al.: Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology 2003, 125:421–428.PubMedCrossRefGoogle Scholar
  31. 31.
    Thumshirn M, Camilleri M, Cho MG, Zinsmeister AR: Modulation of gastric sensory and motor functions by nitrergic and alpha-2 adrenergic agents Gastroenterology 1999, 116:573–585.PubMedCrossRefGoogle Scholar
  32. 32.
    Rosa-e-Silva L, Troncon LE, Oliveira RB, et al.: Treatment of diabetic gastroparesis with oral clonidine. Aliment Pharmacol Ther 1995, 9:179–183.PubMedCrossRefGoogle Scholar
  33. 33.
    Tack J, Coulie B, Andrioli A, Janssens J: Influence of sumatriptan on gastric fundus tone and of the perception of gastric distension in man. Gut 2000, 46:468–473.PubMedCrossRefGoogle Scholar
  34. 34.
    Sarnelli G, Vos R, Sifrim D, et al.: Influence of sildenafil on fasting and postprandial gastric tone in man [abstract]. Gastroenterology 2001, 120:A285–A286.Google Scholar
  35. 35.
    de Rosalmeida MC, Saraiva LD, da Graca JR, et al.: Sildenafil, a phosphodiesterase-5 inhibitor, delays gastric emptying and gastrointestinal transit of liquid in awake rats. Dig Dis Sci 2003, 48:2064–2068.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2007

Authors and Affiliations

  1. 1.Gastroenterology SectionTemple University School of MedicinePhiladelphiaUSA

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