Gastric Emptying Studies ≥3 Hours Show Promotility Agents Work

Stomach and Small Bowel

Vanessa M. Shami, MD, FASGE reviewing Vijayvargiya P, et al. Gastroenterology 2019 Jan 31.

Gastroparesis (GP) can be debilitating, and few treatment options are available. Data on promotility agents to improve gastric emptying (GE) and the resultant effect on upper gastrointestinal symptoms (UGI) are conflicting. These effects, as well as how GE methodology affects the association between change in GE and UGI symptoms, were assessed in a systematic review and meta-analysis.

Studies where there was documented change in GE (T1/2) or composite UGI symptoms were included. The studies were randomized, blinded, parallel, or crossover trials of patients with functional dyspepsia and gastroparesis taking 5-HT4 agonists, D2-receptor antagonists, or ghrelin agonists. Motilin receptor agonists were excluded because of their association with tachyphylaxis. Optimal GE test methods were defined as breath test or scintigraphy measured for >3 hours with solid meals.

The use of promotility agents significantly decreased GE (T1/2) when all studies (regardless of GE test methods) were analyzed. In a subgroup analysis, studies that used optimal GE test methods demonstrated a significantly higher change in GE vs. studies that did not. Promotility agents also reduced UGI symptoms. Using meta-regression to analyze the association between GE and UGI symptoms, there was a significant positive association between improvement in GE and UGI symptoms (p=0.02) only when optimal GE test methodology was used.

Comment:

In patients with gastroparesis, 5-HT4 receptor agonists, D2-receptor antagonists, and ghrelin-receptor agonists improve both GE and UGI symptoms. These results emphasize the importance of GE emptying studies being done properly. Unfortunately, despite an increase in the prevalence of GP, many of these promotility drugs are unavailable in the U.S. Studies such as this one demonstrate how imperative it is to develop or approve drugs that can ameliorate symptoms of GP.

Note to readers: At the time we reviewed this paper, its publisher noted that it was not in final form and that subsequent changes might be made.

Vanessa M. Shami, MD, FASGE

Bio and Disclosures

Citation(s):

Vijayvargiya P, Camilleri M, Chedid V, et al. Effects of promotility agents on gastric emptying and symptoms: A systematic review and meta-analysis. Gastroenterology 2019 Jan 31. (Epub ahead of print) (https://doi.org/10.1053/j.gastro.2019.01.249)