Document Detail


Clinical guideline: management of gastroparesis.
MedLine Citation:
PMID:  23147521     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
This guideline presents recommendations for the evaluation and management of patients with gastroparesis. Gastroparesis is identified in clinical practice through the recognition of the clinical symptoms and documentation of delayed gastric emptying. Symptoms from gastroparesis include nausea, vomiting, early satiety, postprandial fullness, bloating, and upper abdominal pain. Management of gastroparesis should include assessment and correction of nutritional state, relief of symptoms, improvement of gastric emptying and, in diabetics, glycemic control. Patient nutritional state should be managed by oral dietary modifications. If oral intake is not adequate, then enteral nutrition via jejunostomy tube needs to be considered. Parenteral nutrition is rarely required when hydration and nutritional state cannot be maintained. Medical treatment entails use of prokinetic and antiemetic therapies. Current approved treatment options, including metoclopramide and gastric electrical stimulation (GES, approved on a humanitarian device exemption), do not adequately address clinical need. Antiemetics have not been specifically tested in gastroparesis, but they may relieve nausea and vomiting. Other medications aimed at symptom relief include unapproved medications or off-label indications, and include domperidone, erythromycin (primarily over a short term), and centrally acting antidepressants used as symptom modulators. GES may relieve symptoms, including weekly vomiting frequency, and the need for nutritional supplementation, based on open-label studies. Second-line approaches include venting gastrostomy or feeding jejunostomy; intrapyloric botulinum toxin injection was not effective in randomized controlled trials. Most of these treatments are based on open-label treatment trials and small numbers. Partial gastrectomy and pyloroplasty should be used rarely, only in carefully selected patients. Attention should be given to the development of new effective therapies for symptomatic control.
Authors:
Michael Camilleri; Henry P Parkman; Mehnaz A Shafi; Thomas L Abell; Lauren Gerson;
Publication Detail:
Type:  Journal Article; Practice Guideline; Research Support, N.I.H., Extramural     Date:  2012-11-13
Journal Detail:
Title:  The American journal of gastroenterology     Volume:  108     ISSN:  1572-0241     ISO Abbreviation:  Am. J. Gastroenterol.     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-01-04     Completed Date:  2013-02-27     Revised Date:  2013-10-16    
Medline Journal Info:
Nlm Unique ID:  0421030     Medline TA:  Am J Gastroenterol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  18-37; quiz 38     Citation Subset:  IM    
Affiliation:
Department of Gastroenterology, Mayo Clinic, Rochester, MN 55905, USA. camilleri.michael@mayo.edu
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MeSH Terms
Descriptor/Qualifier:
Acupuncture Therapy
Antiemetics / therapeutic use
Botulinum Toxins / therapeutic use
Combined Modality Therapy
Diabetes Complications / diagnosis,  therapy
Diagnosis, Differential
Diet Therapy
Electric Stimulation Therapy
Fluid Therapy
Gastrectomy
Gastric Bypass
Gastrointestinal Agents / therapeutic use
Gastroparesis / diagnosis,  etiology,  therapy*
Gastrostomy
Humans
Neuromuscular Agents / therapeutic use
Nutritional Support
Pylorus / surgery
Grant Support
ID/Acronym/Agency:
1 U01 DK073975-06/DK/NIDDK NIH HHS; DK67071/DK/NIDDK NIH HHS; P01 DK068055/DK/NIDDK NIH HHS; P01 DK68055-04/DK/NIDDK NIH HHS; R01 DK067071/DK/NIDDK NIH HHS; U01 DK073975/DK/NIDDK NIH HHS; U01 DK074007/DK/NIDDK NIH HHS; U01 DK074007/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/Antiemetics; 0/Gastrointestinal Agents; 0/Neuromuscular Agents; EC 3.4.24.69/Botulinum Toxins
Comments/Corrections
Comment In:
Am J Gastroenterol. 2013 Sep;108(9):1539-40   [PMID:  24005361 ]
Am J Gastroenterol. 2013 Sep;108(9):1538-9   [PMID:  24005360 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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