Pharmacy Times

New Guidelines on Gastroparesis


Gastroparesis is a symptomatic chronic disorder of the stomach characterized by delayed gastric emptying (GE) in the absence of mechanical obstruction. Its prevalence is unknown, and its causes are diverse. The American Gastroenterological Association (AGA) recently published its position statement on the diagnosis and treatment of gastroparesis in Gastroenterology (November 2004).

According to the AGA, gastroparesis can be diagnosed in patients with appropriate symptoms (ie, nausea, vomiting, early satiety, postprandial abdominal fullness) when delayed GE has been demonstrated and other potential causes of symptoms have been excluded. Scintigraphy of a radiolabeled solid meal is the best-accepted method for assessing GE in clinical practice; however, the octanoate breath test is used routinely in research and clinical studies.

Primary recommended treatments for gastroparesis include dietary manipulation (more frequent small meals, increased ratio of liquid foods versus solids, and foods low in fat and fiber); antiemetics to reduce nausea and vomiting (phenothiazines are the most common class of agents, but no clearly defined best practice exists); and prokinetic agents to enhance gastric contractility. Emerging treatments mentioned by the AGA for refractory gastroparesis include combination prokinetic therapy, pyloric botulinum toxin injection, and gastric electrical stimulation.