{"id":11241,"date":"2021-11-08T13:30:34","date_gmt":"2021-11-08T12:30:34","guid":{"rendered":"https:\/\/www.endoscopy-campus.com\/?post_type=ec-news&#038;p=11241"},"modified":"2021-11-08T13:30:35","modified_gmt":"2021-11-08T12:30:35","slug":"refractory-gastroparesis-expert-recommendations","status":"publish","type":"ec-news","link":"https:\/\/www.endoscopy-campus.com\/en\/ec-news\/refractory-gastroparesis-expert-recommendations\/","title":{"rendered":"Refractory Gastroparesis: Expert Recommendations"},"content":{"rendered":"\n<p>Gastroparesis is a vexing problem and often has overlapping symptoms with functional dyspepsia. In this update from the American Gastroenterological Association, medically refractory gastroparesis is defined as ongoing symptoms in patients with a confirmed diagnosis of gastroparesis despite appropriate dietary changes and the use of metoclopramide as a first-line therapeutic agent. Algorithms for the diagnosis and management of refractory gastroparesis have not been standardized due to a lack of prospective studies to determine the best approach for these patients. The authors of this clinical practice update used published data and expert review to outline a strategy to define, diagnose, and manage refractory gastroparesis.&nbsp;<\/p>\n\n\n\n<p>Best practice advice:<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Exclude disorders that can be confused for medically refractory gastroparesis, including mechanical obstruction, hypothyroidism, adrenal insufficiency, and functional dyspepsia.&nbsp;&nbsp;<\/li><li>Confirm that the diagnosis is made when the patient is no longer using opioids to manage pain and when the appropriate 4-hour gastric emptying test is employed.<\/li><li>Classify patients with gastroparesis based on symptoms and results of a gastric emptying study: mild (10%-15% retention at 4 hours), moderate (15%-35%), or severe (&gt;35%).<\/li><li>Identify the predominant symptom (nausea and\/or vomiting vs abdominal pain and\/or discomfort), and initiate treatment accordingly.&nbsp;<\/li><li>Antiemetics and prokinetics are options for treating nausea and vomiting.<\/li><li>Neuromodulators should be tried for patients with abdominal pain, whereas opioids should be avoided.&nbsp;<\/li><li>Consider gastric electrical stimulation in patients with refractory nausea and vomiting who have failed other therapies; it is not recommended in patients with pain-predominant gastroparesis.<\/li><li>Consider gastric peroral endoscopic myotomy in a multidisciplinary center for patients with gastroparesis who have severely delayed gastric emptying.<\/li><\/ul>\n","protected":false},"excerpt":{"rendered":"<p>Gastroparesis is a vexing problem and often has overlapping symptoms with functional dyspepsia. In this update from the American Gastroenterological Association, medically refractory gastroparesis is defined as ongoing symptoms in patients with a confirmed diagnosis of gastroparesis despite appropriate dietary changes and the use of metoclopramide as a first-line therapeutic agent. Algorithms for the diagnosis &#8230; <a title=\"Refractory Gastroparesis: Expert Recommendations\" class=\"read-more\" href=\"https:\/\/www.endoscopy-campus.com\/en\/ec-news\/refractory-gastroparesis-expert-recommendations\/\" aria-label=\"Read more about Refractory Gastroparesis: Expert Recommendations\">Read more<\/a><\/p>\n","protected":false},"template":"","categories":[1768,1789],"tags":[2577,3059,2103],"class_list":["post-11241","ec-news","type-ec-news","status-publish","hentry","category-asge-journal-scan","category-stomach-and-small-bowel","tag-american-gastroenterological-association","tag-refractory-gastroparesis","tag-stomach-2"],"_links":{"self":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news\/11241","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/ec-news"}],"about":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/types\/ec-news"}],"wp:attachment":[{"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/media?parent=11241"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/categories?post=11241"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.endoscopy-campus.com\/en\/wp-json\/wp\/v2\/tags?post=11241"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}