Last updated August 8, 2022

Gastroparesis

Risk Factors

In patients with diabetic gastroparesis (DG), optimal glucose control is suggested to reduce the future risk of aggravation of GP. (C, L)
620

SGE is the standard test for the evaluation of GP in patients with upper GI symptoms. The suggested method of testing includes appraising the emptying of a solid meal over a duration of 3 hours or greater. (S, M)
620

Radiopaque markers (ROM) testing is not suggested for the diagnostic evaluation of GP in patients with upper GI symptoms. (C, VL)
620

WMC testing may be an alternative to the SGE assessment for the evaluation of GP in patients with upper GI symptoms. (C, L)
620

Stable isotope (13C-spirulina) breath test is a reliable test for the evaluation of GP in patients with upper GI symptoms. (C, L)
620

Management

Dietary management of GP should include a small particle diet to increase likelihood of symptom relief and enhance GE. (C, L)
620

In patients with idiopathic and DG, pharmacologic treatment should be considered to improve GE and GP symptoms, considering benefits and risks of treatment. (C, L)
620

In patients with GP, we suggest treatment with metoclopramide over no treatment for management of refractory symptoms. (C, L)
620

In patients with GP where domperidone is approved, we suggest use of domperidone for symptom management. (C, L)
620

In patients with GP, we suggest use of 5-HT4 agonists over no treatment to improve GE. (C, L)
620

In patients with GP, use of antiemetic agents is suggested for improved symptom control; however, these medications do not improve GE. (C, L)
620

Central neuromodulators are not recommended for management of GP. (S, M)
620

Current data do NOT support the use of ghrelin agonists for management of GP. (S, M)
620

Current data do NOT support the use of haloperidol for treatment of GP. (C, L)
620

Gastric electric stimulation (GES) may be considered for control of GP symptoms as a humanitarian use device (HUD). (C, L)
620

Acupuncture alone or acupuncture combined with prokinetic drugs may be beneficial for symptom control in patients with DG. Acupuncture cannot be recommended as beneficial for other etiologies of GP. (C, VL)
620

Herbal therapies such as Rikkunshito or STW5 (Iberogast) should NOT be recommended for treatment of GP. (C, L)
620

In patients with GP, EndoFLIP evaluation may have a role in characterizing pyloric function and predicting treatment outcomes after peroral pyloromyotomy. (C, VL)
620

Intrapyloric injection of botulinum toxin is not recommended for patients with GP based on randomized, controlled trials. (S, M)
620

In patients with GP with symptoms refractory to medical therapy, we suggest pyloromyotomy over no treatment for symptom control. (C, L)
620

Recommendation Grading

Abbreviations

  • DG: Diabetic Gastroparesis
  • GE: Gastrointestinal Emptying
  • GES: Gastric Electric Stimulation
  • GI: Gastric Electric Stimulation
  • GP: Gastroparesis
  • SGE: Scintigraphic Gastric Emptying

Overview

Title

Gastroparesis

Authoring Organization

Publication Month/Year

August 5, 2022

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

This guideline presents recommendations for the evaluation and management of patients with gastroparesis. 

Target Patient Population

Patient with gastroparesis

Inclusion Criteria

Male, Female, Adolescent, Adult, Child, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Diagnosis, Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D005746 - Gastric Emptying, D018589 - Gastroparesis

Keywords

surgery, gastric emptying, gastroparesis

Source Citation

Camilleri M, Kuo B, Nguyen L, Vaughn VM, Petrey J, Greer K, Yadlapati R, Abell TL. ACG Clinical Guideline: Gastroparesis. Am J Gastroenterol. 2022 Aug 1;117(8):1197-1220. doi: 10.14309/ajg.0000000000001874. Epub 2022 Jun 3. PMID: 35926490.

Methodology

Number of Source Documents
181
Literature Search Start Date
March 1, 2019
Literature Search End Date
May 1, 2021