skip to main content

Gastroparesis Antiemetic — RACP Adult Medicine MCQ

Instant feedback + full explanation. One question, done properly.

ModerateGastroenterologyGastroparesis AntiemeticRACP Adult Medicine

A 65-year-old woman with diabetic gastroparesis has persistent nausea, vomiting, early satiety, and bloating. Gastric emptying scintigraphy shows delayed emptying (>60% retention at 2 hours). She is on insulin pump therapy. Domperidone was trialled but caused QT prolongation. What is the most appropriate antiemetic?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: A — Metoclopramide (D2 antagonist/prokinetic)

Diabetic gastroparesis with domperidone intolerance (QT prolongation) — metoclopramide is an alternative prokinetic. It crosses the blood-brain barrier (unlike domperidone) causing more CNS side effects (extrapyramidal symptoms, tardive dyskinesia with prolonged use). Use at the lowest effective dose for <12 weeks. Erythromycin (motilin agonist) is another prokinetic option. Dietary modifications (small frequent meals, low-fat, low-fibre) are the foundation of management.

Reference: eTG GI – 2024 – Gastroparesis; AGA 2024