CAG updates gastroparesis guidelines for diagnosis and treatment in ‘continuing innovation’

August 05, 2022

2 minute read


Disclosures: Camilleri reports NIH funding for all studies related to gastroparesis, as well as research funding from Allergan, Takeda, and Vanda and compensation from Alpha Sigma Wasserman and Takeda. Please see the study for relevant financial information from all other authors.

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The American College of Gastroenterology released a new guideline for the diagnosis and management of gastroparesis, which was recently published in Jhe American Journal of Gastroenterology.

“The objective of this new guideline is to document, summarize and update the evidence and develop recommendations for the clinical management of gastroparesis (GP)”, Michael Camilleri, MD, DSc, MRCP, MACG, AGAF, professor of gastroenterology and hepatology at the Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “There is a need to recognize the limitations of therapy guideline recommendations in the absence of FDA approved therapies for general practitioners in the United States and the limitation of prescription duration to 3 months for the only drug currently approved, metoclopramide.”

Takeaways from GP guidelines

The updated recommendations build on previous guidelines published in 2013, which focused on assessing and correcting nutritional status, relieving symptoms, improving gastric emptying and, in patients with diabetes, glycemic control.

From February 2019 to July 2021, Camilleri and colleagues conducted extensive literature searches and reviewed 1,908 references, identifying 121 for inclusion and reviewing the evidence. They then developed 20 recommendations for the diagnosis and management of GPs using the guideline ranking, rating, development and evaluation process.

Highlights of the updated guideline include:

  • Gastric emptying scintigraphy is the standard diagnostic test for general practitioners in patients with upper gastrointestinal symptoms. The suggested test method includes assessment of stomach emptying for 3 hours or more after a solid meal.
  • Dietary management of patients with GP should include a small-particle diet to increase the likelihood of symptom relief and improved gastric emptying.
  • Considering both the benefits and risks of treatment, pharmacological therapies should be considered to improve symptoms in patients with idiopathic or diabetic gastroparesis.
  • In patients with GP, treatment with metoclopramide rather than no treatment is suggested for the management of refractory symptoms, as is the use of 5-HT4 agonists rather than no treatment to improve gastric emptying. Domperidone, if approved, is suggested for symptom management in patients with GP.
  • Pyloromyotomy is suggested in the absence of treatment for symptom control in patients with symptoms refractory to medical treatment. Intrapyloric injection of botulinum toxin is not recommended based on data from randomized controlled trials.

“This guideline has focused on general practitioner diagnosis and treatment in adults (including dietary, pharmacological, operative, and pyloric-directed interventions),” concluded Camilleri and colleagues. “Nevertheless, this is an area where considerable innovation, validation and research are likely to impact future iterations of these guidelines. Such advances should clarify the role of immunotherapies, new pharmacological agents, pyloric interventions, bioelectric therapy and surgical approaches for general practitioners.

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