AGA Clinical Practice Update on Management of Medically Refractory Gastroparesis: Expert Review

DESCRIPTION: Delayed gastric emptying on objective testing defines gastroparesis, but symptoms overlap with functional dyspepsia and do not correlate well with gastric emptying delay. This review outlines a strategy for defining, diagnosing, and managing refractory gastroparesis. METHODS: The Best Practice Advice statements presented here were developed from review of existing literature combined with expert opinion to provide practical advice. Because this was not a systematic review, formal rating of the quality of evidence or strength of recommendations was not performed. BEST PRACTICE ADVICE: 1. Clinicians should review symptoms and evaluate physical examination findings to exclude disorders that can mimic medically refractory gastroparesis. 2. Clinicians should verify appropriate methodology of the gastric emptying study to ensure an accurate diagnosis of delayed gastric emptying. 3. Clinicians should classify patients with gastroparesis into mild, moderate, or severe based on symptoms and the results of a properly performed gastric emptying study. 4. Clinicians should identify the predominant symptom and initiate treatment based on that symptom. 5. Clinicians should be aware of the multiple treatment options to treat nausea and vomiting. 6. Clinicians should consider the use of neuromodulators to treat gastroparesis associated abdominal pain but should not use opioids. 7. Clinicians can consider gastric electrical stimulation for gastroparesis patients with refractory/intractable nausea and vomiting who have failed standard therapy and are not on opioids. 8. Clinicians can consider G-POEM for select refractory gastroparesis patients with severe delay in gastric emptying, using a thoughtful team approach involving motility specialists and advanced endoscopists at a center of excellence.

Automated summary

This article outlines a strategy for defining, diagnosing, and managing refractory gastroparesis, including evaluating symptoms and physical examination findings, verifying the accuracy of gastric emptying studies, classifying patients based on symptoms and study results, and initiating treatment based on the predominant symptom.