Appraisal of medium- and long-term treatment of gastroparesis and chronic intestinal dysmotility.

Abstract

To evaluate the medium- and long-term treatment of patients with gastroparesis and chronic intestinal dysmotility (CID). This assessment is timely, inasmuch as several treatment trials have been published within the past 2 yr, necessitating an appraisal of the outcome of treatments. Literature review based on Medline Search using key words: gastroparesis, chronic intestinal pseudo-obstruction, enteral nutrition, feeding jejunostomy, prokinetics, gastric atony, gastrectomy, Roux-Y gastrectomy. Restoration of nutrition can be achieved orally, enterally, or parenterally, depending on the severity of the clinical syndrome. Combinations of antiemetics and prokinetics are useful for symptomatic and objective benefits. Intravenous erythromycin is chiefly beneficial in the acute presentation. The weight of current evidence favors cisapride as the prokinetic of choice in the medium and long term. Surgical approaches are restricted to providing a means for decompression, access to the small bowel for nutrition, and resection for localized disease or completion of gastrectomies for atony after gastric surgery. More rational choices of access for nutritional supplementation, selection of prokinetic agents, and indications for surgical treatment can be made on the basis of clinical experience and published studies; however, several unanswered questions remain and call for further outcome-based studies in patients with gastroparesis and CID.