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Advances in the management of gastroparesis.
MedLine Citation:
PMID:  17761121     Owner:  NLM     Status:  In-Data-Review    
Abstract/OtherAbstract:
The treatment goals for patients with gastroparesis are to control symptoms; to correct fluid, electrolyte, and nutritional deficiencies; and to identify and treat the underlying cause of gastroparesis. For mild symptoms, dietary modifications and a low-dose antiemetic and/or prokinetic agent might provide satisfactory control of symptoms. Dietary treatments include decreasing the solid food component while increasing the liquid nutrient component of meals. Fat and fiber intake should be minimized. Metoclopramide, despite its potential for neurological side effects, remains a prokinetic treatment for symptomatic patients. In patients with diabetic gastroparesis, careful regulation of glycemic control may help to reduce symptoms. Medical management of patients with gastroparesis who do not respond to initial antiemetic or prokinetic therapy or who develop medication-related side effects involves the use of other prokinetic and antiemetic agents with different mechanisms of action. Combinations of prokinetic and antiemetic agents often are tried in patients with persistent symptoms. In some patients with persistent refractory symptoms and failure to maintain adequate fluid and/or nutritional intake, bypassing the stomach with jejunostomy feedings may be necessary. Gastric electrical stimulation is a treatment for refractory gastroparesis. Based on initial studies showing symptom benefit, especially in patients with diabetic gastroparesis, gastric electrical stimulation was granted humanitarian US Food and Drug Administration approval for the treatment of chronic, refractory nausea and vomiting secondary to idiopathic or diabetic gastroparesis. However, which patients are likely to respond, the optimal electrode position, and the optimal stimulation parameters remain areas that need to be addressed.
Authors:
Frank K Friedenberg; Henry P Parkman
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Current treatment options in gastroenterology     Volume:  10     ISSN:  1092-8472     ISO Abbreviation:  Curr Treat Options Gastroenterol     Publication Date:  2007 Aug 
Date Detail:
Created Date:  2007-08-31     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815941     Medline TA:  Curr Treat Options Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  283-93     Citation Subset:  -    
Affiliation:
Henry P. Parkman, MD Gastroenterology Section, Temple University School of Medicine, Parkinson Pavilion, 8th Floor, 3401 North Broad Street, Philadelphia, PA 19140, USA. henry.parkman@temple.edu.
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