Management of gastroparesis

This month's American Journal of Gastroenterology presents recommendations for the evaluation and management of patients with gastroparesis.

Dr Michael Camilleri and colleagues from Minnesota, USA present recommendations for the evaluation and management of patients with gastroparesis.

Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying.

Symptoms from gastroparesis include nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain.

Management of gastroparesis should include assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying and, in diabetics, glycemic control.

The researh team reported that a patient's nutritional state should be managed by oral dietary modifications.

If oral intake is not adequate, then enteral nutrition via jejunostomy tube needs to be considered.

The doctors noted that parenteral nutrition is rarely required when hydration and nutritional state cannot be maintained.

Second-line approaches include venting gastrostomy

American Journal of Gastroenterology

Medical treatment entails use of prokinetic and antiemetic therapies.

The team found that currently approved treatment options, including metoclopramide and gastric electrical stimulation, do not adequately address clinical need.

The team of researchers discovered that antiemetics have not been specifically tested in gastroparesis, but they may relieve nausea and vomiting.

Other medications aimed at symptom relief include unapproved medications or off-label indications, and include domperidone, erythromycin, and centrally acting antidepressants used as symptom modulators.

The team of doctors found that gastric electrical stimulation may relieve symptoms, including weekly vomiting frequency, and the need for nutritional supplementation, based on open-label studies.

Second-line approaches include venting gastrostomy or feeding jejunostomy.

Intrapyloric botulinum toxin injection was not effective in randomized controlled trials.

Dr Camilleri's team concludes, "Most of these treatments are based on open-label treatment trials and small numbers."

"Partial gastrectomy and pyloroplasty should be used rarely, only in carefully selected patients."

"Attention should be given to the development of new effective therapies for symptomatic control."