Safety of treatment for gastroparesis

ABSTRACT

Introduction: Gastroparesis is a syndrome of chronic, often debilitating symptoms related to impaired gastric motility, resulting in delayed emptying of the stomach, within the setting of a documented absence of any mechanical obstruction in the upper gastrointestinal tract. This disorder manifests with the presence of early satiety, postprandial fullness, nausea, vomiting, bloating and abdominal pain. The past ten years have shown significant advances in knowledge of the pathophysiology of this entity as well as in new diagnostic tests. However, in the clinical world which requires treatment of gastroparetic symptoms, the pharmacological options have been limited and sometimes less than optimal.

Areas covered: This article provides an overview of the safety of the available pharmacological therapies utilized in the treatment of gastroparetic symptoms specifically addressing the safety of prokinetics, antiemetics, sensory neuromodulators and pain modifying agents. In addition, a brief overview of the evolving but yet to be officially approved agents is included.

Expert opinion: None of the medications used for the treatment of gastroparesis are devoid of side effects. Therefore, when prescribing these medications, the risk/benefit ratio should be considered. Since those agents are increasingly administered in combination, awareness of possible drug interactions must be considered in a setting of the patients’ medical history, age, systemic diseases and other medications.

KEYWORDS:

• Gastroparesis
• prokinetic
• antiemetic
• analgesic

Article highlights

• Gastroparesis is a common GI motility disorder with a high economic and health burden.

• Medical treatments for gastroparesis are limited and are usually based on symptomatic therapy and can be classified as: prokinetics, anti-emetics and analgesics.

• Despite the benefits of centrally acting pain modifiers, all these medications have adverse effects which sometimes may limit their therapeutic benefits.

• Drug interaction is an important issue during medical treatment of gastroparesis.

• Before administering any of these medications, possible side-effects should be seriously discussed with the patients. In addition, patients should be monitored for possible adverse effects when a medication is prescribed for gastroparesis.

• Evolving research on new prokinetic and antiemetic agents is also focusing on improving safety profiles, thus offering an exciting future utilization of these drugs in gastroparetic patients.

• A new direction in gastroparesis therapy will be an intervention at the molecular level in electro- mechanical smooth muscle function to prevent cellular changes leading to gastroparesis.

This box summarizes key points contained in the article.

Declaration of interest

I Sarosiek and R McCallum have participated in clinical research trials with Rhythm Pharma, Evoke Pharma, Theravance Pharma and Forest Pharma. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed