ACG Clinical Guideline: Gastroparesis

Abstract

Gastroparesis is characterized by symptoms suggesting retention of food in the stomach with objective evidence of delayed gastric emptying in the absence of mechanical obstruction in the gastric outflow. This condition is increasingly encountered in clinical practice. These guidelines summarize perspectives on the risk factors, diagnosis, and management of gastroparesis in adults (including dietary, pharmacological, device, and interventions directed at the pylorus), and they represent the official practice recommendations of the American College of Gastroenterology. The scientific evidence for these guidelines was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation process. When the evidence was not appropriate for Grading of Recommendations, Assessment, Development, and Evaluation, we used expert consensus to develop key concept statements. These guidelines should be considered as preferred but are not the only approaches to these conditions.

Diagnosis and Management of Gastroparesis

“…Despite challenges, following the evidence-based recommendations provided by the guideline should aid in the management of gastroparesis by improving symptoms and quality of life for this population. Nevertheless, as acknowledged in the new guideline (1), it is necessary to recognize the limitations of guideline recommendations on pharmacotherapies in view of the dearth of the US Food and Drug Administration (FDA)-approved therapies for gastroparesis in the United States and the US FDA-recommended prescription for only 3 months for the only currently approved medication, metoclopramide.…”

“…Gastroparesis is a challenging gastrointestinal condition to manage in clinical practice. The recently published American College of Gastroenterology Guideline on Gastroparesis highlighted major features regarding risk factors, diagnosis, and management of this disorder (1). However, given the complexities of patient care, guideline recommendations can seem impractical or difficult to enact.…”

G-POEM for severe and refractory gastroparesis

“…(2)(3)(4) The ACG guidelines make a conditional recommendation for consideration in patients with refractory symptoms and note a low quality of evidence. (1) The current study by Martinek et al (2022) (5) is a trial of G-POEM in the Czech Republic and Slovakia and is the first to incorporate a sham arm with crossover in severe and refractory gastroparesis. Patients were assessed with EGD, scintigraphy, and symptom and quality of life questionnaires at 3, 6, and 12 months.…”

Editorial: what is needed to achieve success in developing diagnostic technologies for patients with gastrointestinal motility disorders ‐ past and present

“…Guidelines advocate the use of gastrointestinal transit testing to inform subsequent care targeting the underlying physiology with either prokinetics to conceptually hasten motor transit or neuromodulators to improve sensory perception. 1 Traditional testing for slow colon transit utilises a radiopaque marker, small bowel transit utilises barium studies, and gastric emptying utilises gastric scintigraphy. 2 To obviate the need for multiple tests of individual luminal organ systems, the wireless motility capsule (WMC, SmartPill™; Medtronic) was cleared by the U.S. Food and Drug Administration (FDA) in 2006 as an in-office test that measures whole-gut gastrointestinal transit without significant radiation exposure.…”

“…They impair quality of life and are associated with high levels of healthcare resource utilisation. Guidelines advocate the use of gastrointestinal transit testing to inform subsequent care targeting the underlying physiology with either prokinetics to conceptually hasten motor transit or neuromodulators to improve sensory perception 1 . Traditional testing for slow colon transit utilises a radiopaque marker, small bowel transit utilises barium studies, and gastric emptying utilises gastric scintigraphy 2 .…”