Gastroparesis
Publication Date: August 5, 2022
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
Disclaimer
Overview
Title
Gastroparesis
Authoring Organization
American College of Gastroenterology
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.
Supplemental Methodology Resources
Methodology
Number of Source Documents
181
Literature Search Start Date
March 1, 2019
Literature Search End Date
May 1, 2021