Abstract

Prokinetics have limited effectiveness for treating symptoms of gastroparesis. Thus, alternative or adjunct therapies like gastroparesis diets or neuromodulators are often prescribed. Their therapeutic benefits alone or in combination remain unclear.129 patients with symptoms of gastroparesis underwent wireless motility capsule gastric emptying time (GET) and gastric emptying scintigraphy (GES). Based on test results, changes in therapy were recommended. Changes in Gastroparesis Cardinal Symptom Index (GCSI) and individual symptom scores over 6 months were related to recommendations for prokinetics, gastroparesis diet, or neuromodulators given as solo new therapies or in dual combinations. Multivariate analyses were performed to adjust for gastric emptying and other variables.In the whole group regardless of therapy, GCSI scores decreased by 0.53 points (IQR -1.25, 0.05, P < .0001) over 6 months. GCSI did not decrease for prokinetics as solo new therapy (P = .95). Conversely, neuromodulators as solo therapy decreased GCSI scores (P = .04) and all individual symptoms except nausea/vomiting (P = .86). Prokinetics combined with gastroparesis diets or neuromodulators improved GCSI scores (P< .04) and most individual symptoms. Adjusting for GET on multivariate analyses showed greater GCSI decreases for non-delayed emptying for neuromodulators as solo new therapy (P = .01). GES, gender, diabetes, and functional dyspepsia did not influence responses to any treatment.Initiating prokinetics as solo new therapy had little benefit for patients with symptoms of gastroparesis. Neuromodulators as the only new therapy decreased symptoms other than nausea and vomiting, especially with non-delayed gastric emptying. Adding gastroparesis diets or neuromodulators to prokinetics offered relief, suggesting that combination therapies may be more useful in managing these patients. (ClinicalTrials.gov NCT02022826).

View details for DOI 10.1016/j.cgh.2023.10.014

View details for PubMedID 37913936