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Prokinetics in patients with gastroparesis: a systematic analysis
A Sturm1, G Holtmann, H Goebell
1Department of Gastroenterology and Hepatology, Division of Medicine, University of Essen, Germany.
Digestion
|September 4, 1999
Summary
Erythromycin demonstrated the strongest effect on gastric emptying and symptom improvement in gastroparesis patients. However, improvements in gastric emptying did not correlate with symptom relief.
Area of Science:
- Gastroenterology
- Pharmacology
Background:
- Gastroparesis management lacks systematic comparison of prokinetic drug efficacy.
- Understanding relative prokinetic potency is crucial for optimizing patient treatment.
Purpose of the Study:
- To systematically assess and compare the effects of different prokinetic agents on gastroparesis symptoms and gastric emptying.
- To evaluate available data on prokinetic efficacy in gastroparetic patients.
Main Methods:
- Conducted a systematic literature review from 1980 to March 1998.
- Assessed study characteristics, treatment regimens, dosages, study design, and outcome measurements.
- Included 36 studies involving 514 patients treated with oral prokinetics.
Main Results:
- Most studies exhibited methodological limitations, including unblinded treatments and non-validated symptom measurements.
- Erythromycin showed the most significant improvement in gastric emptying compared to domperidone, cisapride, and metoclopramide.
- Erythromycin and domperidone yielded greater symptom score improvements than other prokinetics.
Conclusions:
- Methodological limitations in existing trials restrict definitive conclusions.
- Erythromycin appears superior for accelerating gastric emptying; erythromycin and domperidone are most effective for symptom improvement.
- No clear association was found between enhanced gastric emptying rates and symptom improvement in gastroparesis.