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Pharmacologic treatments for gastroparesis
Open accessAbstract
Gastroparesis is a neurogastrointestinal disorder of motility in which patients experience symptoms of nausea, vomiting, bloating, early satiety, postprandial fullness, upper abdominal discomfort or pain, and delayed gastric emptying of solids based on scintigraphy or stable isotope breath test when mechanical obstruction has been excluded. Symptoms of gastroparesis may result from diverse pathophysiological mechanisms, including antroduodenal hypomotility, pylorospasm, increased gastric accommodation, and visceral hypersensitivity. The most common etiologies of gastroparesis are idiopathic, diabetic, and postsurgical, and less frequent causes are neurodegenerative disorders (Parkinson's disease), myopathies (scleroderma, amyloidosis), medication-induced (glucagon-like peptide-1 agonists and opioid agents), and paraneoplastic syndrome. This review addresses pharmacologic management of gastroparesis including prokinetic and antiemetic agents, pharmacologic agents targeting the pylorus, and effects of neuromodulators. SIGNIFICANCE STATEMENT: Gastroparesis is a neurogastrointestinal motility disorder characterized by delayed gastric emptying without mechanical obstruction with numerous upper gastrointestinal symptoms, including nausea and vomiting. The management of gastroparesis involves nutritional support, medications, and procedures. The only Food and Drug Administration-approved medication for gastroparesis is metoclopramide. This article reviews the pharmacology and efficacy of all classes of antiemetics or prokinetic effects used in gastroparesis. There is still a considerable unmet need for efficacious medications specifically for the treatment of gastroparesis, especially in refractory cases.
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“Prokinetics, such as metoclopramide and erythromycin, modifies emptying times and may require earlier or split bolus dosing to avoid early hypoglycemia [2, 3, 14, 119, 120]”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [120]
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“Metoclopramide, the only drug approved by the FDA for gastroparesis, is limited to < 12 weeks due to extrapyramidal and tardive dyskinesia risk [3, 14, 120, 121]”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [120]
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“although their efficacy is often limited and long-term use requires careful monitorg for adverse effects [2, 14, 120].”
From Diabetic gastroparesis: pathophysiology and impact on insulin timing choices (2026) · cites this paper as [120]
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Ni, Q., Wu, C., Lang, D.-Q., Cai, W.-F., Chen, Q.-C., Jiang, C.-P., Yi, Y.-K., Liu, L., & Shen, C.-Y. (2025) · Industrial crops and products (Print) · doi:10.1016/j.indcrop.2025.121466 · Cited by 4
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“Delayed gastric emptying is an important manifestation of several disorders, including diabetes and medication-related gastrointestinal adverse effects [1,2].”
Diabetic gastroparesis: pathophysiology and impact on insulin timing choices
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Metadata
- Authors
- Camilleri, M., & Jencks, K. J.
- Affiliations
- Mayo Clinic (US)
- Corresponding author
- Camilleri, Michael
- Venue
- Pharmacological Reviews
- Publisher
- Elsevier BV
- Published
- 2025-03
- Volume
- 77
- Issue
- 2
- Pages
- 100019
- ISSN
- 0031-6997 (ISSN-L)
- PMC
- PMC12599987
- OpenAlex
- W4406090389
- Cited by
- 14
- References
- 226
- Citations by year
- 2026: 9 · 2025: 4
- FWCI
- 3.09
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Pharmacological Reviews (acceptedVersion)
- PubMed (publishedVersion)
- PubMed Central (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- Funders
- National Institutes of Health
- Topics
- Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
- Health Sciences › Medicine › Surgery › Nausea and vomiting management
- Health Sciences › Medicine › Gastroenterology › Gastroesophageal reflux and treatments
- Keywords
- gastroparesis, delayed gastric emptying, prokinetic agents, antiemetics, metoclopramide, neuromodulators, diabetic gastroparesis, visceral hypersensitivity, GLP-1 receptor agonists, refractory gastroparesis
- MeSH terms
- Animals, Antiemetics, Gastric Emptying, Gastrointestinal Agents, Humans, Gastroparesis
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