Gastroparesis, or delayed gastric emptying of solids in the absence of mechanical obstruction, is a chronic debilitating disorder that can lead to malnutrition, hospitalization, and severely impaired quality of life. It often results from long-standing diabetes mellitus or vagal nerve injury, but it can be idiopathic.
A review article in the December 2003 edition of Medscape General Medicine focuses on gastroparesis and its treatments. The authors, Daniel C. Buckles, MD, and colleagues, explain the physiologic interactions among gastric neurohumoral, myoelectrical, and contractile functions that are involved in normal gastric physiology. Also, they discuss current strategies for clinical management. Presently, gastroparesis is treated using a stepwise approach, beginning with hydration and nutrition restoration. Antiemetics and prokinetic agents are used to treat nausea and to restore coordinated gastric and small bowel motility, respectively.Yet, the currently available prokinetic agents such as cisapride are often ineffective in providing symptomatic relief and are associated with intolerable adverse effects. The authors discuss as novel treatment options new medical therapies such as tegaserod, a selective serotonin type 4 receptor agonist, as well as nonpharmacologic therapies such as gastric electrical stimulation.