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Practical management approach to gastroparesis.

Kieran J Longley1, Vincent Ho2,3

  • 1Department of Medicine, Campbelltown Hospital, Sydney, New South Wales, Australia.

Internal Medicine Journal
|July 18, 2019
PubMed
Summary

Gastroparesis, a condition of delayed stomach emptying, significantly impacts patients with symptoms like nausea and pain. This study proposes a management framework for gastroparesis in Australia, addressing nutritional deficits and motility issues.

Keywords:
diabetesenteral feedinggastroparesisprokinetic

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Area of Science:

  • Gastroenterology
  • Clinical Medicine

Background:

  • Gastroparesis is characterized by delayed gastric emptying without mechanical obstruction.
  • Symptoms include early satiety, pain, bloating, vomiting, and nutritional deficits, with higher prevalence in diabetics and females.
  • Gastroparesis incidence in Australia requires further study.

Purpose of the Study:

  • To propose a framework for managing gastroparesis in Australia.
  • To outline current evidence and available therapies for gastroparesis management.
  • To address challenges in symptom control and nutritional deficits associated with gastroparesis.

Main Methods:

  • Review of current evidence and available therapies for gastroparesis.
  • Development of a management framework based on nutritional support, glycaemic control, and motility enhancement.
  • Consideration of dietary modification, enteral feeding, and parenteral nutrition.
  • Evaluation of prokinetic medications (dopamine receptor antagonists, motilin receptor agonists, 5-HT4 receptor agonists, ghrelin receptor agonists) and anti-emetic agents.
  • Assessment of interventional treatments including gastric electrical stimulation, gastric per-oral endoscopic myotomy, and feeding jejunostomy.

Main Results:

  • Nutritional deficits are a primary concern, initially managed by dietary modification.
  • Enteral feeding serves as a second-line option for insufficient oral intake.
  • Various prokinetic and anti-emetic medications are utilized for symptom control and motility improvement.
  • Interventional procedures offer advanced treatment options for refractory cases.

Conclusions:

  • A structured approach is needed to manage gastroparesis effectively in Australia.
  • Management should integrate nutritional support, glycaemic control, and prokinetic therapies.
  • The proposed framework aims to optimize care for Australian patients with gastroparesis.