What pharmacological treatments are available for managing gastroparesis, and how effective are they?

Pharmacological management of gastroparesis primarily involves prokinetic agents and antiemetics to improve gastric emptying and alleviate symptoms. Metoclopramide is the first-line prokinetic treatment recommended, as it enhances gastric motility by dopamine D2 receptor antagonism and has some antiemetic properties; however, its use is limited by potential extrapyramidal side effects and a maximum recommended duration of 12 weeks NICE NG17. Domperidone, another dopamine antagonist, is often used as an alternative with fewer central nervous system side effects, but it requires cardiac monitoring due to risk of QT prolongation NICE NG17. Erythromycin, a macrolide antibiotic, acts as a motilin receptor agonist and can be used short-term to stimulate gastric emptying, though tachyphylaxis often limits its long-term effectiveness Feigenbaum 2006. Antiemetics such as ondansetron or prochlorperazine may be added to control nausea and vomiting symptoms but do not affect gastric motility NICE NG17.

Despite these options, pharmacological treatments often provide only partial symptomatic relief, and long-term efficacy remains challenging, especially in diabetic gastroparesis where neuropathic changes impair gastric function Zhou et al. 2024. Emerging therapies targeting novel pathways are under investigation but are not yet standard care Stevens et al. 2013. Therefore, current pharmacotherapy should be individualized, balancing symptomatic benefit against side effects, and integrated with dietary and glycaemic control measures NICE NG17.