New Guidelines on Gastroparesis

Gastroparesis is a symptomatic chronicdisorder of the stomach characterizedby delayed gastric emptying (GE) in theabsence of mechanical obstruction. Itsprevalence is unknown, and its causesare diverse. The American GastroenterologicalAssociation (AGA) recently publishedits position statement on the diagnosisand treatment of gastroparesis inGastroenterology (November 2004).

According to the AGA, gastroparesis canbe diagnosed in patients with appropriatesymptoms (ie, nausea, vomiting, early satiety,postprandial abdominal fullness) whendelayed GE has been demonstrated andother potential causes of symptoms havebeen excluded. Scintigraphy of a radiolabeledsolid meal is the best-acceptedmethod for assessing GE in clinical practice;however, the octanoate breath test is usedroutinely in research and clinical studies.

Primary recommended treatments forgastroparesis include dietary manipulation(more frequent small meals, increasedratio of liquid foods versussolids, and foods low in fat and fiber);antiemetics to reduce nausea and vomiting(phenothiazines are the most commonclass of agents, but no clearlydefined best practice exists); and prokineticagents to enhance gastric contractility.Emerging treatments mentioned bythe AGA for refractory gastroparesisinclude combination prokinetic therapy,pyloric botulinum toxin injection, and gastricelectrical stimulation.