Mohit Kumar1, Adam Chapman2, Saad Javed3, Uazman Alam4, Rayaz A Malik5, Shazli Azmi6. 1. Royal Albert Edward Infirmary Wrightington, Wigan and Leigh National Health Service Foundation Trust, Wigan, United Kingdom. 2. Aintree University Hospital National Health Service Foundation Trust, Liverpool, United Kingdom. 3. Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom. 4. Division of Endocrinology, Diabetes and Gastroenterology, University of Manchester, Manchester, United Kingdom; Diabetes and Endocrinology Research and the Pain Research Institute, Department of Eye and Vision Sciences, Institute of Ageing and Chronic Disease, University of Liverpool and Aintree University Hospital NHS Foundation Trust, Liverpool, United Kingdom; Department of Diabetes and Endocrinology, Royal Liverpool and Broadgreen University NHS Hospital Trust, Liverpool, United Kingdom. 5. Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Weill Cornell Medicine-Qatar, Doha, Qatar. 6. Institute of Cardiovascular Sciences, University of Manchester, Manchester, United Kingdom; Manchester Diabetes Centre, Manchester University Foundation Trust, Manchester, United Kingdom. Electronic address: Shazli.azmi@manchester.ac.uk.
Abstract
PURPOSE: This review provides an update on the investigations and treatment options for gastroparesis. METHODS: A comprehensive literature search of Medline, PubMed, Embase and OVID was conducted which included all systematic reviews and research articles that focused on the diagnosis, investigations and management diabetic gastroparesis. FINDINGS: Dietary modifications and pharmacologic treatment with prokinetics to increase gastric motility form the mainstay of treatment. However, the use of prokinetics is limited by adverse effects and serious adverse effects, leaving metoclopramide as the only drug approved by the US Food and Drug Administration for the treatment of gastroparesis. Newer therapies, including motilin receptor agonists, ghrelin receptor agonists, and neurokinin receptor antagonists, are currently being investigated. Transpyloric stenting, gastric electrical stimulation, and gastric per-oral endoscopic myotomy provide mechanical options for intervention, and surgical interventions in severe intractable gastroparesis include laparoscopic pyloroplasty or gastrectomy. IMPLICATIONS: Advances to better understand the pathophysiology and management of diabetic gastroparesis have been limited, especially with discordance between symptoms and severity of delay in gastric emptying. Established treatment options are limited; however, recent pharmacologic and surgical interventions show promise.
PURPOSE: This review provides an update on the investigations and treatment options for gastroparesis. METHODS: A comprehensive literature search of Medline, PubMed, Embase and OVID was conducted which included all systematic reviews and research articles that focused on the diagnosis, investigations and management diabetic gastroparesis. FINDINGS: Dietary modifications and pharmacologic treatment with prokinetics to increase gastric motility form the mainstay of treatment. However, the use of prokinetics is limited by adverse effects and serious adverse effects, leaving metoclopramide as the only drug approved by the US Food and Drug Administration for the treatment of gastroparesis. Newer therapies, including motilin receptor agonists, ghrelin receptor agonists, and neurokinin receptor antagonists, are currently being investigated. Transpyloric stenting, gastric electrical stimulation, and gastric per-oral endoscopic myotomy provide mechanical options for intervention, and surgical interventions in severe intractable gastroparesis include laparoscopic pyloroplasty or gastrectomy. IMPLICATIONS: Advances to better understand the pathophysiology and management of diabetic gastroparesis have been limited, especially with discordance between symptoms and severity of delay in gastric emptying. Established treatment options are limited; however, recent pharmacologic and surgical interventions show promise.
Authors: Ditte S Kornum; Astrid J Terkelsen; Davide Bertoli; Mette W Klinge; Katrine L Høyer; Huda H A Kufaishi; Per Borghammer; Asbjørn M Drewes; Christina Brock; Klaus Krogh Journal: J Clin Med Date: 2021-03-31 Impact factor: 4.241