Treatment of Autonomic Neuropathy in Gastroparesis

Autonomic neuropathy can affect gastric motility, leading to gastroparesis — delayed gastric emptying that presents with upper gastrointestinal symptoms or erratic glycemic management without another identified cause.

Clinical Scenario

This protocol applies to autonomic neuropathy occurring in the setting of gastroparesis. Gastroparesis should be suspected in individuals with erratic glycemic management or with upper gastrointestinal symptoms without another identified cause.

Treatment Approach

In severe cases, the approach centers on pharmacologic prokinetic therapy. The specific agents, their indications, and clinical sequencing are detailed in the full protocol.

References

DOI: 10.2337/dc26-S012

Gastroparesis should be suspected in individuals with erratic glycemic management or with upper gastrointestinal symptoms without another identified cause.
In cases of severe gastroparesis, pharmacologic interventions are needed.
Only metoclopramide, a prokinetic agent, is approved by the FDA for the treatment of gastroparesis.
It should be reserved for severe cases that are unresponsive to other therapies.
Other treatment options include domperidone (available outside the U.S.) and erythromycin, which is only effective for short-term use due to tachyphylaxis.

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