2025 AGA Guidelines for Management of Gastroparesis - Guideline Summary - Guideline Central
Summary of Recommendations
Document Overview

Management of Gastroparesis

American Gastroenterological Association


Publication Date: Sep 19, 2025

Page Last Updated: May 5, 2026

View External Image

GRADE Strength of Recommendations and Implications

GradeQuality of Evidence
HighWe are very confident that the true effect lies close to the estimate of the effect.
ModerateWe are moderately confident that the true effect lies close to that of the estimate of the effect. There is a possibility that it is substantially different.
LowOur confidence that the true effect lies close to that of the estimate of the effect is low. The true effect may be substantially different from the estimate of the effect.
Very lowWe have very little confidence in the effect estimate. The true effect is likely to be substantially different from the estimate of effect.
Evidence / Knowledge GapAvailable evidence insufficient to determine true effect.
GradeStrength of Recommendation 
Strong
“AGA recommends...”		For the PatientFor the ClinicianFor policy makers
Most individuals in this situation would want the recommended course and only a small proportion would not.Most individuals should receive the intervention. Formal decision aids are not likely to be needed to help individuals make decisions consistent with their values and preferences.The recommendation can be adapted as policy or performance measure in most situations.
Conditional (weak)
“AGA suggests...”		The majority of individuals in this situation would want the suggested course, but many would not.Different choices will be appropriate for individual patients consistent with his or her values and preferences. Use shared decision making. Decision aids may be useful in helping patients make decisions consistent with their individual risks, values, and preferences.Policy making will require substantial debate and involvement of various stakeholders. 
Performance measures should assess whether decision making is appropriate.
No recommendation
“AGA makes no recommendation...”		 The confidence in the effect estimate is so low that any effect estimate is speculative at this time. 

Document Overview

Document Title
Management of Gastroparesis
Authoring Society

American Gastroenterological Association

Document Publication Date
Sep 19, 2025
Page Last Reviewed/Updated
May 5, 2026
Document Type
Guideline
Country of Publication
United States
Full Text Freely Available
Yes
Full Text Guideline
www.gastrojournal.org/article/S0016-5085(25)05857-3/fulltext
Source Citation

Staller K, Parkman HP, Greer KB, Leiman DA, Zhou MJ, Singh S, Camilleri M, Altayar O; AGA Clinical Guidelines Committee. AGA Clinical Practice Guideline on Management of Gastroparesis. Gastroenterology. 2025 Oct;169(5):828-861. doi: 10.1053/j.gastro.2025.08.004. PMID: 40976635.

Supplemental Implementation Resources

Document Scope, Criteria, and Use Cases

Document Objectives

The purpose of these recommendations is to provide evidence-based guidance for patients with suspected and confirmed gastroparesis, mainly idiopathic and diabetes-related gastroparesis, including gastroparesis refractory to medical therapies based on a systematic and comprehensive synthesis of the literature. In addition, the document provides areas where further evidence is needed. Gastroparesis is a complex gastric motility disorder characterized by nausea, vomiting, and other symptoms associated with a delay in gastric emptying in the absence of mechanical obstruction. Variations in diagnostic testing and limited effective treatments make caring for this patient population challenging. The American Gastroenterological Association developed this guideline to provide recommendations for ensuring an accurate diagnosis and identifying evidence-based, effective treatments among the available pharmacologic and procedural interventions for patients with idiopathic gastroparesis or gastroparesis related to diabetes. The diagnosis of gastroparesis requires the use of 4-hour gastric emptying tests. Metoclopramide or erythromycin is appropriate for initial pharmacologic treatment. Other treatment recommendations require shared patient-physician decision making. There are still considerable unmet needs in the treatment of gastroparesis.

Scope
Assessment and Screening, Diagnosis, Management
Diseases/Conditions (MeSH)

D000932 - Antiemetics

D018589 - Gastroparesis

D000932 - Antiemetics

D018589 - Gastroparesis

Keywords
Endoscopic Myotomy, Neuromodulator, Prokinetic, Pyloroplasty, antiemetic, diabetes-related gastroparesis, gastroparesis, idiopathic gastroparesis, prokinetic agents
Target Patient Population
Patients with suspected and confirmed gastroparesis
Target Provider Population
Health care providers in the field of gastroenterology and primary care who care for patients with suspected and confirmed gastroparesis
Inclusion Criteria
Male, Female, Adult, Older Adult
Health Care Settings
Ambulatory, Outpatient
Intended Users
Nurse, Nurse Practitioner, Physician, Physician Assistant

Recommendation Development Processes & Methodology

PICO Questions
  1. Should 2-hour vs 4-hour gastric emptying studies be used to diagnose gastroparesis?
  2. Should metoclopramide be used for the treatment of individuals with gastroparesis?
  3. Should erythromycin be used for the treatment of individuals with gastroparesis?
  4. Should domperidone be used for the treatment of individuals with gastroparesis?
  5. Should prucalopride be used for the treatment of individuals with gastroparesis?
  6. Should neurokinin-1 receptor antagonists be used for the treatment of individuals with gastroparesis?
  7. Should nortriptyline, as a neuromodulator, be used for the treatment of individuals with gastroparesis?
  8. Should buspirone, as a neuromodulator, be used for the treatment of individuals with gastroparesis?
  9. Should cannabidiol be used for the treatment of individuals with gastroparesis?
  10. Should pyloric botulinum toxin injection (BTI) be used for the treatment of individuals with gastroparesis refractory to medical therapy?
  11. Should gastric peroral endoscopic pyloromyotomy (G-POEM) be used for the treatment of individuals with gastroparesis refractory to medical therapy?
  12. Should surgical pyloric interventions (pyloromyotomy or pyloroplasty) be used for the treatment of individuals with gastroparesis refractory to medical therapy?
  13. Should gastric electrical stimulation (GES) be used for the treatment of individuals with gastroparesis refractory to medical therapy?
Supplemental Methodology Resource
Data Supplement
You rely on Guideline Central for transparency

Guideline Central and select third party use “cookies” on this website to enhance the user experience.

This technology helps us gather statistical and analytical information to optimize the relevant content for you.

The user also has the option to opt-out which may have an effect on the browsing experience.