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)
-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
@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
💡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
Increasingly being used off label for GP
Extragastric dysmotility is COMMON in gastroparesis
💡 Prucalopride is a great option in GP patients with constipation
💡 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
💡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
-think about with extraintestinal, autoimmune, and autonomic symptoms and/or family history (also think paraneoplastic)
-autoantibody workup
-treat with IVIG or methylprednisolone
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