AGA Unveils Comprehensive Guidelines on Gastroparesis

The American Gastroenterological Association (AGA) has released groundbreaking clinical practice guidelines aimed at managing the often-misunderstood condition of gastroparesis. With 12 pivotal recommendations, these guidelines serve to streamline diagnosis and enhance treatment protocols for patients suffering from this complex gastric motility disorder.

Aiming for Accurate Diagnosis and Effective Treatments

Published in *Gastroenterology* on September 19, 2025, the guidelines emphasize the need for accurate diagnosis and evidence-based treatments, particularly for cases of idiopathic gastroparesis and those tied to diabetes. Dr. Kyle Staller, a leading gastroenterologist, highlights the intention behind these guidelines: to empower clinicians to evaluate the benefits and risks of treatments for their patients, fostering individualized care.

Expert Recommendations from a Specialized Panel

Developed by an expert panel of clinicians and methodologists, the guidelines underwent extensive review, including public commentary and input from peers in the field. The 12 recommendations focus on critical aspects of diagnosis and treatment, drawn from robust clinical evidence.

Key Takeaways for Diagnosis and Treatment

One notable recommendation advises against the use of shorter gastric emptying studies (2 hours or less) for evaluating delayed gastric emptying due to high misdiagnosis rates. Instead, a 4-hour test is favored for its accuracy.

Regarding treatment, metoclopramide and erythromycin are conditionally recommended for easing symptoms of gastroparesis. Metoclopramide has shown significant efficacy in alleviating nausea and other major symptoms, though it comes with an FDA black box warning for potential adverse effects. Erythromycin, while effective based on limited evidence, also bears warnings related to liver toxicity and drug interactions.

Caution Against Certain Treatments and Procedures

The AGA also cautions against the use of several medications—domperidone, prucalopride, and others—as first-line treatments, underscoring the need for targeted therapies. Additionally, they recommend reserving surgical options like gastric peroral endoscopic pyloromyotomy (G-POEM) for select patients resistant to other medical therapies.

Call for More Research and Future Directions

Despite these advancements, the AGA identified significant unmet needs within the realm of gastroparesis treatment. They advocate for further research, including randomized controlled trials, to better evaluate surgical interventions and improve patient outcomes.

Conclusion: A Step Forward in Gastroparesis Care

These new guidelines mark a significant step forward in the management of gastroparesis, aiming to enhance the quality of care for patients while spotlighting the need for continued research in this challenging area of gastroenterology.