Gastroparesis is characterised by the cardinal symptoms of nausea, vomiting, early satiety, and postprandial fullness. First-line management is pharmacologic, and the goal is meaningful, sustained symptom reduction assessed over the first weeks of therapy.
The first-line strategy uses pharmacologic prokinetic therapy. More than one evidence-supported agent is available at this stage, each with its own dosing schedule and tolerability profile.
The specific agents, dose titration, and full sequencing are detailed in the structured protocol — see below.
In individuals with gastroparesis, the AGA suggests using metoclopramide.
In individuals with gastroparesis, the AGA suggests using erythromycin.
Medication efficacy and adverse effects, including movement disorders, are usually assessed at 4–8 weeks to decide whether the treatment should be continued.
DOI: 10.1053/j.gastro.2025.08.004
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