Gastroparesis is a chronic condition that affects the stomach’s ability to empty its contents in a timely manner. This disorder, sometimes referred to as delayed gastric emptying, can significantly impact quality of life. The exploration of current and emerging drug treatments for this challenging condition is a focus of ongoing medical research.
Understanding Gastroparesis
Gastroparesis involves the stomach taking too long to empty food into the small intestine. This delay occurs because the nerves and muscles that control stomach contractions are not functioning effectively.
Common symptoms associated with gastroparesis include nausea, vomiting, bloating, and a feeling of fullness very quickly after starting a meal. Patients may also experience abdominal pain, a poor appetite, and unintentional weight loss. These symptoms can vary in severity and may occur at unpredictable times, sometimes even between meals or at night.
In 30% to 50% of cases, the cause remains unknown, termed idiopathic gastroparesis. Diabetes is a common cause, accounting for about one-third of cases, as high blood sugar can damage nerves controlling stomach function. Gastroparesis can also develop following surgery due to potential damage to nerves or stomach muscles.
Existing Treatment Approaches
Current management strategies for gastroparesis include dietary adjustments. Eating smaller, more frequent meals can help reduce the burden on the stomach. Consuming low-fat and low-fiber foods, which are generally easier to digest, is also recommended. Maintaining adequate hydration is an important part of managing symptoms.
Medications that encourage stomach emptying, known as prokinetic agents, are used. Metoclopramide is the only drug approved by the U.S. Food and Drug Administration (FDA) for gastroparesis. It works by increasing muscle contractions in the stomach and relaxing the pylorus, the opening to the small intestine, thereby speeding up food passage. However, metoclopramide can have side effects, including neurological issues with long-term use.
Another prokinetic, domperidone, is available in some regions and can be accessed in the U.S. through a compassionate use program due to potential cardiac risks. Erythromycin, an antibiotic, also has prokinetic effects and can stimulate stomach contractions, though its effectiveness may decrease over time. To address nausea and vomiting, antiemetic medications like ondansetron or promethazine are prescribed, though these do not directly improve gastric emptying. These existing treatments aim to alleviate symptoms, but they do not provide a cure.
Emerging Drug Therapies
Several promising drug candidates are under investigation. These new therapies often target different mechanisms to improve gastric motility or reduce symptoms.
One class of drugs being explored are ghrelin receptor agonists, such as relamorelin. This medication mimics the action of ghrelin, a hormone that stimulates appetite and gastric motility. Clinical trials have shown that relamorelin can accelerate gastric emptying and help reduce symptoms like vomiting. Its development aims to provide a treatment with potentially fewer side effects than current options.
Serotonin receptor modulators are another area of investigation. Prucalopride, a selective serotonin 5-HT4 receptor agonist, is primarily used for chronic constipation but is being researched for its potential to stimulate gut motility in gastroparesis. This drug works by enhancing the natural contractions of the gastrointestinal tract. Additionally, aprepitant, a neurokinin-1 receptor antagonist, is approved for chemotherapy-induced nausea and vomiting and is being explored for its utility in managing severe nausea associated with gastroparesis.
What to Discuss With Your Doctor
When considering treatment for gastroparesis, it is important to have a comprehensive discussion with your healthcare provider. A gastroenterologist can help tailor a treatment plan to your specific needs. They can assess existing options and determine which might be most suitable for your condition.
Individualized care is important because gastroparesis can present differently in each person, with varying symptoms and underlying causes. Your doctor may also discuss participating in clinical trials for emerging therapies, offering access to new treatments that are not yet widely available. A dietitian can provide guidance on dietary modifications that may help manage symptoms. Open communication with your medical team ensures that all available avenues for managing gastroparesis are explored.