Benefits of Prokinetics, Gastroparesis Diet, or Neuromodulators Alone or in Combination for Symptoms of Gastroparesis

William L Hasler; Allen A Lee; Baharak Moshiree; Brian C Surjanhata; Satish Rao; Henry P Parkman; Linda A Nguyen; Irene Sarosiek; John M Wo; Michael I Schulman; Richard W McCallum; Braden Kuo

doi:10.1016/j.cgh.2023.10.014

Benefits of Prokinetics, Gastroparesis Diet, or Neuromodulators Alone or in Combination for Symptoms of Gastroparesis

Clin Gastroenterol Hepatol. 2024 Apr;22(4):867-877.e12. doi: 10.1016/j.cgh.2023.10.014. Epub 2023 Oct 30.

Authors

Affiliations

¹ Gastroenterology and Hepatology, Mayo Clinic Arizona, Scottsdale, Arizona. Electronic address: Hasler.William@mayo.edu.
² Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan.
³ Atrium Health Wake Forest Baptist, Morehead Medical Plaza, Charlotte, North Carolina.
⁴ Division of Gastroenterology, Massachusetts General Hospital, Boston, Massachusetts.
⁵ Division of Gastroenterology and Hepatology, Medical College of Georgia, Augusta, Georgia.
⁶ Section of Gastroenterology, Temple University, Philadelphia, Pennsylvania.
⁷ Division of Gastroenterology, Stanford University, Palo Alto, California.
⁸ Section of Gastroenterology, Texas Tech University, El Paso, Texas.
⁹ Division of Gastroenterology and Hepatology, Indiana University, Indianapolis, Indiana.
¹⁰ Florida Digestive Health Associates, Largo, Florida.

PMID: 37913936
DOI: 10.1016/j.cgh.2023.10.014

Abstract

Background & aims: Prokinetics have limited effectiveness for treating symptoms of gastroparesis. Thus, alternative or adjunct therapies, such as gastroparesis diets or neuromodulators, are often prescribed. Their therapeutic benefits alone or in combination remain unclear.

Methods: One hundred and twenty-nine patients with symptoms of gastroparesis underwent wireless motility capsule gastric emptying time and gastric emptying scintigraphy. 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.

Results: In the whole group regardless of therapy, GCSI scores decreased by 0.53 points (interquartile range, -1.25 to 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 gastric emptying time on multivariate analyses showed greater GCSI decreases for nondelayed emptying for neuromodulators as solo new therapy (P = .01). Gastric emptying scintigraphy, gender, diabetes, and functional dyspepsia did not influence responses to any treatment.

Conclusions: 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 nondelayed 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.).

Keywords: Gastric Emptying Scintigraphy; Multivariate Analyses; Symptom Outcomes; Wireless Motility Capsule.

Publication types

Clinical Trial

MeSH terms

Diet
Gastric Emptying / physiology
Gastroparesis* / diagnosis
Gastroparesis* / drug therapy
Humans
Nausea
Neurotransmitter Agents / therapeutic use
Treatment Outcome
Vomiting

Substances

Neurotransmitter Agents

Associated data

ClinicalTrials.gov/NCT02022826