AGA has released a new Clinical Practice Update in the March issue of Clinical Gastroenterology and Hepatology providing best practice advice for the management of medically refractory gastroparesis.
In the new AGA Clinical Practice Update on Management of Medically Refractory Gastroparesis: Expert Review, Drs. Brian E. Lacy, Jan Tack and C. Prakash Gyawali provide guidance to assist in managing your patients with foregut symptoms attributed to gastroparesis, noting that a diagnosis of refractory gastroparesis requires persistent symptoms in the context of reliably established emptying delay.CLINICAL PRACTICE ADVICE
- Review symptoms and evaluate physical examination findings to exclude disorders that can mimic medically refractory gastroparesis.
- Verify appropriate methodology of the gastric emptying study to ensure an accurate diagnosis of delayed gastric emptying.
- Classify patients with gastroparesis into mild, moderate or severe based on symptoms and the results of a properly performed gastric emptying study.
- Identify the predominant symptom and initiate treatment based on that symptom.
- Consider multiple treatment options to treat nausea and vomiting.
- Consider the use of neuromodulators to treat gastroparesis-associated abdominal pain, but should not use opioids.
- Consider gastric electrical stimulation for gastroparesis patients with refractory/intractable nausea and vomiting who have failed standard therapy and are not on opioids.
- Consider G-POEM for select refractory gastroparesis patients with severe delay in gastric emptying, using a thoughtful team approach involving motility specialists and advanced endoscopists at a center of excellence.
In the short video below, lead author Brian Lacy MD, PhD, from the Mayo Clinic, highlights the best practice advice statements to address key issues in clinical management of these patients: