Reprogramming of gastric motility with "pulse therapy" (metoclopramide and erythromycin) in severe gastroparesis

Abstract

Gastroparesis is a very common condition, however many times it becomes difficult to manage even after long-term treatment due to multiple etiologies or improper therapy. Patients with severe gastroparesis are considered candidates for gastric electrical stimulants. The "Pulse Therapy" using metoclopramide and erythromycin to reprogram gastric motility can delay or even avoid the need for gastric electrical stimulants. This case report focuses on a patient with severe gastroparesis, who was considered for a gastric pacemaker implantation and was instead treated successfully with "Pulse Therapy." As a part of this regimen, he was given metoclopramide continuously for 3 months along with pulses of erythromycin for 10 days a month for 3 months. Patient recovered dramatically that he no longer remained a candidate for gastric pacemaker implantation. This case study emphasizes on how the proper use of prokinetic agents based on symptoms and gastric emptying study can reprogram the stomach motility in these patients with severe gastroparesis.

Keywords

• Diabetic gastroparesis
• erythromycin
• gastric emptying study
• gastroparesis
• Helicobacter pylori
• idiopathic gastroparesis
• metoclopramide
• past Helicobacter pylori infection
• prokinetic agents
• severe gastroparesis