Gastroparesis Dietary recommendations

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Family Medicine Board Review : Pearls of Wisdom, Fourth EditionThe correct answer is B

Primary treatment of gastroparesis includes dietary manipulation and administration of antiemetic and prokinetic agents.

Dietary recommendations include eating frequent smaller-size meals and replacing solid food with liquids, such as soups. Foods should be low in fat and fiber content.
Antiemetic agents are administered for nausea and vomiting. The principal classes of antiemetic drugs are antidopaminergics, antihistamines, anticholinergics, and more recently serotonin receptor antagonists. The antiemetic action of phenothiazine compounds is primarily due to a central antidopaminergic mechanism in the area postrema of the brain. Commonly used agents include prochlorperazine, trimethobenzamide, and promethazine.

Serotonin (5-HT3) receptor antagonists are helpful in treating or preventing chemotherapy-induced nausea and vomiting. The sites of action of these compounds include the area postrema as well as peripheral afferent nerves. These agents are frequently used for nausea and vomiting due to other etiologies with little published evidence demonstrating their efficacy. These agents are best used on an as-needed basis.

Current prokinetic agents include metoclopramide and erythromycin, which can be administered orally or intravenously.

Patients refractory to the initial treatment of gastroparesis can be difficult to manage. Treatment may involve switching prokinetic and antiemetic agents, combining prokinetic agents, injecting botulinum toxin into the pylorus, using gastrostomy/jejunostomy tubes, and implanting a gastric electric stimulator.

A treatment recently reported to be helpful for refractory gastroparesis is endoscopic injection of botulinum toxin into the pyloric sphincter. Botulinum toxin, which reduces the release of acetylcholine from cholinergic nerves, may relax pyloric sphincter resistance, allowing more food to empty from the stomach.
Decompressing gastrostomy and feeding jejunostomy tubes are occasionally used when necessary. A jejunostomy tube may provide a route for administering enteral nutrition, hydration, and medications.

Gastric electric stimulation is an emerging therapy for refractory gastroparesis. There are several ways to stimulate the stomach by varying the electrical parameters. With gastric electrical pacing, the goal is to entrain and pace the gastric slow waves at a higher rate than the patient's normal myoelectric frequency.




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