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Current and future treatment management strategies for gastroparesis

ABSTRACT Introduction: Gastroparesis (GP) is a debilitating condition characterized by delayed gastric emptying (GE) after gastric outlet obstruction has been excluded. GP is a debilitating condition affecting more than 10 million patients, which is approximately 3% of US population. In this review, we will elaborate on the current treatment options for GP, recent advancement in its management and its future directions. Areas covered: Combination of antiemetics and prokinetics is the current management strategy. The only Food and Drug Administration (FDA) approved agent for GP is Metoclopramide but it has a black box warning for tardive dyskinesia. Several new drugs with different mechanism of action are currently being investigated with encouraging efficacy and minimal side effects. Also, advancement in non-pharmacological management such as gastric neurostimulator and per-oral endoscopic pyloromyotomy (G-POEM) has shown benefit in GP. Expert opinion: Current management of GP continues to be a challenge with only one approved drug (metoclopramide). However, many new potential treatment options are under development, with advances in understanding the pathophysiology of GP. Other future treatment possibilities involve advances in regenerative medicine, particularly stem cell-based transplantation targeting ICC depletion and enteric nerve damage.