Thread by @john_damianosMD

#Gastroparesis updates with @LindaNguyenMD

#MedTwitter #GITwitter #motility #ACG2022

Updated @AmCollegeGastro #gastroparesis guidelines

I've summarized the guidelines here👇

https://twitter.com/john_damianosMD/status/1555928081885536256?s=20&t=auZSzP2a31R5RykCq8BHzA

Importance of an *optimized* gastric emptying study
-standardized solid meal
-measure at least 3 hours (ideally 4)

Even with optimized GES, gastric emptying *fluctuates* over time, without any change in symptoms

@LindaNguyenMD thinks of this like #IBS, how bowel habits can change over time

Small particle diet improves #gastroparesis symptoms (this allows patients to eat FIBER!)

Prokinetic options

Mixed data as to whether accelerating gastric emptying improves symptoms.

Metoclopramide is the ONLY FDA_approved drug for gastroparesis

💡Risk of tardive diskinesia is lower than previously thought, especially in #gastroparesis. Risk factors can also help risk stratify

Domperidone (IND with FDA)

Motilin agonists are limited by tachyphylaxis

Prucalopride is approved for constipation, not gastroparesis, but GP symptoms do improve on this agent

Increasingly being used off label for GP

Extragastric dysmotility is COMMON in gastroparesis

💡 Prucalopride is a great option in GP patients with constipation

Pyridostigmine also improves constipation, so is another good option in gastroparesis patients with constipation

Nonpharmacologic treatments for gastroparesis

Intrapyloric Botox may be an option for patients with decreased pyloric distensability (on FLIP)

G-POEM improves symptoms

Gastric electrical stimulation improves nausea/vomiting scores, but not abdominal pain or bloating

💡Think GES in nausea/vomiting predominant gastroparesis

Refractory gastroparesis: consider predominant symptom (nausea/vomiting 🆚 abdominal pain) and severity of symptoms

Functional dyspepsia and delayed gastric emptying are associated with more severe symptoms

Autoimmune gastrointestinal dysmotility
-think about with extraintestinal, autoimmune, and autonomic symptoms and/or family history (also think paraneoplastic)
-autoantibody workup
-treat with IVIG or methylprednisolone

@LindaNguyenMD summary on #gastroparesis