ACG updates gastroparesis guidelines for diagnosis, treatment amid ‘ongoing innovation’

August 05, 2022

2 min read

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 all other authors’ relevant financial disclosures.

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The American College of Gastroenterology has issued a new guideline for the diagnosis and management of gastroparesis, which recently was published in The 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 Mayo Clinic in Rochester, Minnesota, and colleagues wrote. “It is necessary to acknowledge the limitations of guideline recommendations on therapies in the absence of FDA-approved therapies for GP in the United States and the limitation in duration of prescription to 3 months for the only currently approved medication, metoclopramide.”

GP guideline takeaways

The updated recommendations build upon previous guidelines published in 2013, which focused on assessment and correction of nutritional state, symptom relief, improvement of gastric emptying and, in patients with diabetes, glycemic control.

From February 2019 to July 2021, Camilleri and colleagues conducted extensive literature searches and screened 1,908 references, identifying 121 for inclusion and evidence review. They then developed 20 recommendations for the diagnosis and management of GP using the Grading of Recommendations, Assessment, Development and Evaluation process.

Highlights from the updated guideline include:

  • Scintigraphic gastric emptying is the standard diagnostic test for GP among patients with upper gastrointestinal symptoms. Suggested method of testing includes evaluation of stomach emptying over 3 hours or more following a solid meal.
  • Dietary management of patients with GP should include a small particle diet to increase the likelihood of symptom relief and enhanced gastric emptying.
  • Considering both benefits and risks of treatment, pharmacologic therapies should be considered to improve symptoms in patients with idiopathic or diabetic gastroparesis.
  • In patients with GP, treatment with metoclopramide is suggested over no treatment for management of refractory symptoms, as is use of 5-HT4 agonists over no treatment to improve gastric emptying. Domperidone, if approved, is suggested for symptom management in patients with GP.
  • Pyloromyotomy is suggested over no treatment for symptom control in patients with symptoms refractory to medical therapy. Intrapyloric injection of botulinum toxin is not recommended based on data from randomized controlled trials.

“This guideline has focused on the diagnosis and treatment of GP in adults (including dietary, pharmacological, device and interventions directed at the pylorus),” Camilleri and colleagues concluded. “Nevertheless, this is an area with considerable ongoing innovation, validation and research that is likely to impact future iterations of these guidelines. Such advances should clarify the role of immunotherapies, novel pharmacological agents, pyloric interventions, bioelectric therapy and surgical approaches for GP.”

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