Table 1.
Gastroparesis Recommendations
| Recommendation | GRADE Level of Evidence | Strength of Recommendation | |
|---|---|---|---|
| Risk Factors | |||
| 1. | In patients with diabetic gastroparesis, optimal glucose control is suggested to reduce the future risk of aggravation of gastroparesis. | Low | Conditional |
| Diagnostic Testing | |||
| 2. | Scintigraphic gastric emptying assessment is the standard test for the evaluation of gastroparesis in patients with upper GI symptoms. The suggested method of testing includes appraising the emptying of a solid meal over a duration of 3 hours or greater. | Moderate | Strong |
| 3. | Radiopaque markers testing is not suggested for the diagnostic evaluation of gastroparesis in patients with upper GI symptoms. | Very Low | Conditional |
| 4. | Wireless motility capsule testing may be alternative to the scintigraphic gastric emptying assessment for the evaluation of gastroparesis in patients with upper GI symptoms. | Low | Conditional |
| 5. | Stable isotope (13C-spirulina) breath testing is a reliable test for the evaluation of gastroparesis in patients with upper GI symptoms. | Low | Conditional |
| Management | |||
| 6. | Dietary management of gastroparesis should include a small particle diet to increase likelihood of symptom relief and enhanced gastric emptying. | Low | Conditional |
| 7. | In patients with idiopathic and diabetic gastroparesis, pharmacologic treatment should be considered to improve gastric emptying and gastroparesis symptoms, taking into account benefits and risks of treatment. | Low | Conditional |
| 8. | In patients with gastroparesis, we suggest treatment with metoclopramide over no treatment for management of refractory symptoms | Low | Conditional |
| 9. | In patients with gastroparesis where domperidone is approved, we suggest use of domperidone for symptom management | Low | Conditional |
| 10. | In patients with gastroparesis, we suggest use of 5HT4 agonists over no treatment to improve gastric emptying | Low | Conditional |
| 11. | In patients with gastroparesis, use of antiemetic agents is suggested for improved symptom control, however, these medications do not improve gastric emptying. | Low | Conditional |
| 12. | Central neuromodulators are not recommended for management of gastroparesis. | Moderate | Strong |
| 13. | Current data do NOT support the use of ghrelin agonists for management of gastroparesis. | Moderate | Strong |
| 14. | Current data do NOT support the use of haloperidol for treatment of gastroparesis. | Low | Conditional |
| 15. | Gastric electric stimulation (GES) may be considered for control of gastroparesis (GP) symptoms as a humanitarian use device (HUD) | Low | Conditional |
| 16. | Acupuncture alone or acupuncture combined with prokinetic drugs may be beneficial for symptom control in patients with diabetic gastroparesis. Acupuncture cannot be recommended as beneficial for other etiologies of gastroparesis. | Very Low | Conditional |
| 17. | Herbal therapies such as Rikkunshito or STW5 (Iberogast) should NOT be recommended for treatment of gastroparesis. | Low | Conditional |
| 18. | In patients with gastroparesis, EndoFLIP evaluation may have a role in characterizing pyloric function and predicting treatment outcomes following peroral pyloromyotomy. | Very Low | Conditional |
| 19. | Intrapyloric injection of botulinum toxin is not recommended for patients with gastroparesis based on randomized controlled trials. | Moderate | Strong |
| 20. | In patients with gastroparesis with symptoms refractory to medical therapy, we suggest pyloromyotomy over no treatment for symptom control. | Low | Conditional |