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Clinical Guideline: Management of Gastroparesis

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Camilleri, Michael, Parkman, Henry P, Shafi, Mehnaz A, Abell, Thomas L, Gerson, Lauren·2013·American Journal of Gastroenterology
DOI 10.1038/ajg.2012.373PMC PMC3722580
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Abstract

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.

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  • Individuals with type 1 and type 2 diabetes have about a twofold increased risk of developing a range of cardiovascular diseases compared with those without diabetes.

    “Individuals with type 1 and type 2 diabetes have about a twofold increased risk of developing”

    From ESPEN guideline on hospital nutrition (2021) · cites this paper as [177]

    The guideline’s section on identifying the cause of gastroparesis reports its incidence in people with type 1 and type 2 diabetes versus controls, not cardiovascular disease risk. Searches for a twofold cardiovascular risk and for cardiovascular disease, myocardial infarction, and stroke found no passage in our copy addressing the claimed comparison. (LLM, conf=0.76)

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Cited by

Sorted by citations

Authors
Camilleri, M., Parkman, H. P., Shafi, M. A., Abell, T. L., & Gerson, L.
Affiliations
  • Mayo Clinic (US)
  • Temple University (US)
  • The University of Texas MD Anderson Cancer Center (US)
  • University of Mississippi (US)
  • Stanford University (US)
Corresponding author
Camilleri, Michael
ORCID
Venue
American Journal of Gastroenterology
Publisher
Ovid Technologies (Wolters Kluwer Health)
Published
2013-01
Volume
108
Issue
1
Pages
18-37
ISSN
0002-9270 (ISSN-L)
DOI
10.1038/ajg.2012.373
PMC
PMC3722580
OpenAlex
W2122114281
Cited by
1,149
References
16
Citations by year
2026: 48 · 2025: 77 · 2024: 62 · 2023: 89 · 2022: 100 · 2021: 135 · 2020: 120 · 2019: 120 · 2018: 82 · 2017: 89 · 2016: 73 · 2015: 64 · 2014: 58 · 2013: 24 · 2012: 2
FWCI
45.95
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (unspecified)
Locations
  • The American Journal of Gastroenterology (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
Funders
National Institute of Diabetes and Digestive and Kidney Diseases (DK67071, P01 DK68055-04, R56DK067071, P01DK068055, R01DK067071, U01DK074007, U01DK073975)
Topics
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal motility and disorders
  • Health Sciences › Medicine › Gastroenterology › Gastrointestinal Bleeding Diagnosis and Treatment
  • Health Sciences › Medicine › Surgery › Enhanced Recovery After Surgery
Keywords
gastroparesis, delayed gastric emptying, diabetic gastroparesis, nutritional assessment, prokinetic agents, metoclopramide, gastric electrical stimulation, antiemetics, domperidone, erythromycin, antidepressants, jejunostomy, parenteral nutrition, botulinum toxin injection, partial gastrectomy, pyloroplasty, nausea and vomiting
MeSH terms
Antiemetics, Botulinum Toxins, Combined Modality Therapy, Diagnosis, Differential, Diet Therapy, Electric Stimulation Therapy, Fluid Therapy, Gastrectomy, Gastrointestinal Agents, Gastrostomy, Humans, Neuromuscular Agents, Pylorus, Gastric Bypass, Acupuncture Therapy, Nutritional Support, Gastroparesis, Diabetes Complications

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