Gastroparesis

Gastroparesis is a disorder characterized by a delay in gastric emptying of a meal in the absence of a mechanical gastric outlet obstruction

Diagnosis of gastroparesis is based on the presence of symptoms such as nausea, vomiting and postprandial abdominal fullness and on an objectively determined delay in gastric emptying

• gastric emptying can be assessed by scintigraphy and stable isotope breath tests
  • gold standard of diagnosis is solid meal gastric scintigraphy

Management principles (4):

• Non-pharmacological options
  • non-pharmacological options are usually tried before prokinetic agents
    • dietary modification should be tried first line ensuring the person’s diet is low in fat and non-digestible fibre
    • advise the person to avoid spicy and acidic foods, as well as carbonated drinks. Switching to liquid or small particle diets, such as broths and mashed foods, can also improve symptoms
• Prokinetic options
  • if non-pharmacological options do not relieve symptoms, consider using a prokinetic medicine
  • no medicines are licensed as prokinetics in the UK
  • first-line prokinetic medicines are metoclopramide and domperidone. Metoclopramide is approved in the United States for diabetic gastroparesis
    • domperidone is approved in Canada for gastrointestinal motility disorders associated with gastritis and diabetic gastroparesis
  • erythromycin is a second-line option.
  • other options include prucalopride and cisapride (discontinued in the UK)

Management of gastroparesis consists of dietary and lifestyle measures and/or pharmacological interventions (prokinetics, antiemetics, intrapyloric botulinum toxin injection) or other interventions that focus on adequate nutrient intake either through a nasoduodenal tube, percutaneous gastrostomy or jejunostomy

• most patients with mild disease will respond to dietary and lifestyle measures and prokinetics such as domperidone, metoclopramide and erythromycin

Notes:

• diabetes mellitus is associated with a spectrum of gastric emptying abnormalities: Upper abdominal symptoms resembling functional dyspepsia were thought to be due to underlying delayed gastric emptying
  • transient slow gastric emptying
  • transient fast gastric emptying
  • persistent slow or delayed gastric emptying (gastroparesis)
  • persistent fast gastric emptying
  • delayed gastric emptying may cause difficulty in glucose control in patients receiving insulin therapy (3)
  • rapid gastric emptying plays an important role in the genesis and progression of type 2 diabetes mellitus (3)
  • similar symptoms are associated with rapid gastric emptying, suggesting that gastroparesis may not be the cause of the symptoms (3)
    

References:

1. Waseem S, Moshiree B, Draganov PV. Gastroparesis: current diagnostic challenges and management considerationsWorld J Gastroenterol. 2009 Jan 7;15(1):25-37.
2. Haans JJ, Masclee AA.The diagnosis and management of gastroparesis. Aliment Pharmacol Ther. 2007 Dec;26 Suppl 2:37-46,
3. Goyal RJ. Gastric Emptying Abnormalities in Diabetes Mellitus.N Engl J Med 2021;384:1742-51. DOI: 10.1056/NEJMra2020927.
4. NHS Speciality Pharmacy Service (May 2025). Choosing a prokinetic medicine for impaired gastrointestinal motility.