Treatment of severely delayed gastric emptying

For the drug treatment of gastroparesis, domperidone, metoclopramide and cisapride may be prescribed as prokinetics. Positive effects on the rate of emptying of the stomach, dyspeptic symptoms and quality of life are best documented for cisapride. Simultaneous use of cisapride with substances that inhibit the metabolism of cisapride or that may lengthen the QT interval, is contraindicated because of the risk of arrhythmias. Erythromycin is a powerful prokinetic, but because of its antibiotic effects it is usually prescribed only for a brief period. For patients who in spite of drug treatment have persistent unacceptable symptoms and keep losing weight, invasive treatment should be considered. The first step is then insertion of a jejunal tube, followed, if necessary, by antrectomy with Billroth-I reconstruction. The next step is subtotal gastrectomy with Roux-Y reconstruction, this may result in abatement of the symptoms, which, however, rarely disappear altogether.