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Idiopathic and Diabetic Gastroparesis
Deirdre O'Donovan1, Christine Feinle-Bisset, Karen Jones
1Department of Medicine, University of Adelaide, Level 6, Eleanor Harrald Building, Frome Road, Adelaide, SA 5000, Australia. michael.horowitz@adelaide.edu.au
Current Treatment Options in Gastroenterology
|July 9, 2003
Summary
Managing gastroparesis, a condition affecting gastric emptying, presents challenges due to limited evidence. Treatment focuses on nutrition, glycemic control in diabetics, and a trial of prokinetic drugs, with individualized long-term therapy.
Area of Science:
- Gastroenterology
- Endocrinology
Background:
- Diabetic and idiopathic gastroparesis management is clinically challenging.
- Current understanding of gastroparesis pathophysiology and natural history is limited.
- Most pharmacologic trials are short-term with methodological flaws.
Purpose of the Study:
- To outline management principles for diabetic and idiopathic gastroparesis.
- To emphasize the importance of nutrition and glycemic control.
- To discuss therapeutic options including prokinetic agents and novel therapies.
Main Methods:
- Review of current management strategies for gastroparesis.
- Discussion of pharmacologic agents, including prokinetics.
- Consideration of nutritional support, glycemic control, and surgical options.
Main Results:
- Adequate nutrition and optimized glycemic control are crucial.
- A 4-week trial of prokinetic therapy is reasonable, despite symptom-based diagnosis limitations.
- Limited prokinetic agents (metoclopramide, erythromycin, cisapride) have side effects; combination therapy may be beneficial.
Conclusions:
- Individualized medical therapy is key, considering patient factors.
- Surgery is an option for refractory cases in specialized centers.
- Novel therapies like gastric electrical stimulation are under investigation.