This protocol applies to gastroparesis in a patient with diabetes mellitus — commonly called diabetic gastroparesis (DG). It is indicated when an adequate trial of pharmacologic therapy targeting improved gastric emptying and symptom reduction has not achieved its goals, leaving the patient with medically refractory gastroparesis.
A pharmacologic regimen was trialed with the aim of improving gastric emptying and reducing gastroparesis symptoms. This line included prokinetic and antiemetic agents such as metoclopramide, domperidone, 5-HT4 agonists, motilin agonists, and related treatments, with or without acupuncture. When this approach fails to adequately control symptoms, the structured next-step protocol below applies.
The primary objectives are decreased vomiting frequency and sustained control of gastroparesis symptoms.
DOI: 10.14309/ajg.0000000000001874
In patients with diabetic gastroparesis (DG), optimal glucose control is suggested to reduce the future risk of aggravation of GP (conditional recommendation, low level of evidence).
Acupuncture alone or acupuncture combined with prokinetic drugs may be beneficial for symptom control in patients with DG. Acupuncture cannot be recommended as beneficial for other etiologies of gastroparesis.
Gastric electric stimulation (GES) may be considered for control of GP symptoms as a humanitarian use device (HUD) (conditional recommendation, low quality of evidence).
GES is approved as an HUD, as defined by the FDA for medically refractory DG or IG.
A recent randomized, crossover trial of ON vs OFF GES in patients with medically refractory vomiting with or without delayed GE, GES decreased the vomiting frequency.
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