A quick look at the latest ACG guidelines for gastroparesis

Lead

Gastroparesis is characterized by symptoms suggesting food retention in the stomach, objective evidence of delayed gastric emptying, and no mechanical obstruction
of the gastric outflow tract.

Table 1 Recommendations for gastroparesis

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

11.

12.

13.

14.

15.

16.
Acupuncture alone or acupuncture combined with prokinetic agents may be beneficial to symptom control
in patients with gastroparesis.
Acupuncture cannot be recommended as beneficial for other causes of gastroparesis (conditionally recommended, very low-quality evidence).

17.
Herbal therapies are not recommended for the treatment of gastroparesis, such as rikkunshito or STW5 (Iberogast) (conditionally recommended, the quality of the evidence is low).

18.
In patients with gastroparesis, EndoFLIP evaluation may play a role in characterizing pyloric function and predicting treatment outcomes after oral pyloric myotomy (conditionally recommended, very low-quality evidence).

19.
Based on randomized controlled trials (highly recommended, moderate quality of evidence), intrapyloric botulinum toxin
injection in patients with gastroparesis is not recommended.

20.
For patients with gastroparesis who do not respond to medical therapy, we recommend that pyloric myotomy be preferred over no treatment to control symptoms (conditionally recommended, low quality of evidence).

Conclusion and looking to the future

This guideline focuses on the diagnosis and treatment of gastroparesis in adults (including diet, pharmacology, instrumentation, and interventions for pyloria
).
The recommendations made are guided
by an assessment using the GRADE methodology.
However, this is an area where a lot of innovation, validation, and research is underway that could affect future iterations
of these guidelines.
In particular, the following have potential future implications for the management of gastroparesis: the diagnostic value of wireless power capsules for gastroparesis and the diagnostic value for measuring pangastrointestinal transport and pressure curves as well as autonomic nervous system dysfunction is being studied
.
Similarly, research is exploring the best ways to select and individualize patients for treatment, including recording circulating antibodies, pyloric measurements and high-resolution anterior duodenal manometry, extensive surface EGG (high-resolution electrograms), and full-layered antral and pyloric biopsies
.
These advances should elucidate the role
of immunotherapy, novel drugs, pyloric interventions, bioelectrotherapy, and surgical approaches to gastroparesis.

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