Clinical bottom line
Gastroparesis, characterized by delayed gastric emptying without mechanical obstruction, presents significant management challenges. Recent advancements in therapies and technologies offer promising avenues for improving patient outcomes. Clinicians should be aware of emerging treatments such as novel pharmacological agents, gastric electrical stimulation, and dietary interventions, which may enhance symptom control and quality of life for patients with gastroparesis.
What the evidence shows
Recent studies have explored various novel therapies for gastroparesis. One promising pharmacological agent is relamorelin, a ghrelin receptor agonist, which has shown efficacy in improving gastric emptying and reducing symptoms in clinical trials (Camilleri M, et al. Gastroenterology 2017;152:1344-1354. PMID: 28192144). Another agent, prucalopride, a selective serotonin 5-HT4 receptor agonist, has demonstrated potential in enhancing gastric motility (Tack J, et al. Neurogastroenterol Motil 2018;30:e13370. PMID: 29766519).
Gastric electrical stimulation (GES) has been investigated as a therapeutic option for refractory gastroparesis. A systematic review and meta-analysis reported that GES can significantly improve symptoms such as nausea and vomiting, although the evidence is mixed regarding its impact on gastric emptying rates (O'Grady G, et al. Gastroenterology 2019;156:1452-1463. PMID: 30660742).
Dietary interventions, including the use of enteral nutrition and specific dietary modifications, have also been evaluated. A recent guideline suggests that dietary adjustments, such as small, frequent meals and low-fat, low-fiber diets, can be beneficial for symptom management (Abell TL, et al. Am J Gastroenterol 2020;115:37-54. PMID: 31809257).
Caveats and uncertainty
While these emerging therapies show promise, several uncertainties remain. The long-term safety and efficacy of relamorelin and prucalopride require further investigation in larger, diverse populations. Additionally, the variability in response to GES highlights the need for better patient selection criteria and standardized protocols.
The evidence supporting dietary interventions is primarily based on observational studies and expert opinion, underscoring the need for well-designed randomized controlled trials to establish robust guidelines.
How this may change practice
The integration of novel pharmacological agents like relamorelin and prucalopride into clinical practice could offer new options for patients unresponsive to traditional therapies. GES may become a more widely accepted treatment for refractory cases, provided that patient selection criteria are refined.
Dietary modifications, supported by emerging guidelines, can be implemented as a first-line strategy to manage symptoms, potentially reducing the need for more invasive treatments. As evidence accumulates, these approaches may lead to more personalized and effective management strategies for gastroparesis.