Severe gastroparesis: new treatment alternatives.
Dopamine antagonists, such as metoclopramide and domperidone, and the motilin receptor agonist erythromycin have been the cornerstones in drug treatment of severe gastroparesis for more than a decade. No new drugs have been approved for treatment of this disorder in this period. Instead, the 5-HT4 agonist cisapride has been withdrawn due to side-effects. The effectiveness of intrapyloric botulinum toxin for gastroparesis remains to be shown. In the last decade, gastric electrical stimulation (GES) with a fully implantable device has evolved as a promising treatment, with significant effects on nausea and vomiting in most patients with severe, drug-refractory diabetic gastroparesis and postsurgical gastroparesis. A proportion of patients with severe idiopathic gastroparesis and patients with idiopathic nausea and vomiting also respond. More research is needed to achieve precise selection of responders/non-responders to GES, and to study the potential benefit of GES in other patient groups suffering from severe nausea or vomiting.
Abrahamsson
Hasse
H
Department of Internal Medicine, Sahlgrenska University Hospital, S-413 45 Göteborg, Sweden. hasse.abrahamsson@medic.gu.se
D018492:Dopamine Antagonists / Q000627:therapeutic use; D004599:Electric Stimulation Therapy; D005765:Gastrointestinal Agents / Q000627:therapeutic use; D018589:Gastroparesis / Q000628:therapy*; D006801:Humans; D011964:Receptors, Gastrointestinal Hormone / Q000819:agonists; D018013:Receptors, Neuropeptide / Q000819:agonists
D018492:Dopamine Antagonists; D005765:Gastrointestinal Agents; D011964:Receptors, Gastrointestinal Hormone; D018013:Receptors, Neuropeptide; C050802:motilin receptor