title: Reprogramming of Gastric Motility with "Pulse Therapy" (Metoclopramide and Erythromycin) in Severe Gastroparesis.
abstract: Gastroparesis is a very common condition, however many times it becomes difficult to manage even after long-term treatment due to multiple etiologies or improper therapy. Patients with severe gastroparesis are considered candidates for gastric electrical stimulants. The "Pulse Therapy" using metoclopramide and erythromycin to reprogram gastric motility can delay or even avoid the need for gastric electrical stimulants. This case report focuses on a patient with severe gastroparesis, who was considered for a gastric pacemaker implantation and was instead treated successfully with "Pulse Therapy." As a part of this regimen, he was given metoclopramide continuously for 3 months along with pulses of erythromycin for 10 days a month for 3 months. Patient recovered dramatically that he no longer remained a candidate for gastric pacemaker implantation. This case study emphasizes on how the proper use of prokinetic agents based on symptoms and gastric emptying study can reprogram the stomach motility in these patients with severe gastroparesis.
authors.affiliation: Department of Medicine, Division of Gastroenterology, University Hospital, Rutgers - New Jersey Medical School, Newark, NJ, USA.
authors.forename: Shamik
authors.initials: S
authors.lastname: Shah
authors.affiliation: Department of Medicine, Division of Gastroenterology, University Hospital, Rutgers - New Jersey Medical School, Newark, NJ, USA.
authors.forename: Dharmesh
authors.initials: D
authors.lastname: Kaswala
authors.affiliation: Department of Medicine, Division of Gastroenterology, University Hospital, Rutgers - New Jersey Medical School, Newark, NJ, USA.
authors.forename: Nishith
authors.initials: N
authors.lastname: Patel
authors.affiliation: Department of Medicine, Division of Gastroenterology, University Hospital, Rutgers - New Jersey Medical School, Newark, NJ, USA.
authors.forename: Sunita
authors.initials: S
authors.lastname: Sood
authors.affiliation: Department of Medicine, Division of Gastroenterology, University Hospital, Rutgers - New Jersey Medical School, Newark, NJ, USA.
authors.forename: Zamir
authors.initials: Z
authors.lastname: Brelvi
keywords: Diabetic gastroparesis; Helicobacter pylori; erythromycin; gastric emptying study; gastroparesis; idiopathic gastroparesis; metoclopramide; past Helicobacter pylori infection; prokinetic agents; severe gastroparesis