The relation between symptom improvement and gastric emptying in the treatment of diabetic and idiopathic gastroparesis

Am J Gastroenterol. 2013 Sep;108(9):1382-91. doi: 10.1038/ajg.2013.118.


Objectives: The relationship between symptom improvement (SI) and acceleration of gastric emptying (GE) for different drugs used in the treatment of idiopathic and diabetic gastroparesis is uncertain. In this paper we examined the study-specific correlations between SI and GE, and we performed a meta-regression analysis of the association across multiple studies.

Methods: The MEDLINE database (1,946 to present) was searched, and only controlled trials or trials with an established effective comparator that compared both SI and GE were included.

Results: Studies were identified for metoclopramide (n=6), domperidone (n=6), cisapride (n=14), erythromycin (n=3), botulinum toxin (n=2), and levosulpiride (n=3). Even though most drugs concomitantly improved symptoms and accelerated GE, no study reported a significant correlation between SI and GE. Moreover, a correlation analysis over all studies using meta-regression did not show a significant relationship between SI and GE. Our findings need to be qualified by inconsistencies in study methods, which is a limitation but also suggests that our findings are robust to methodological factors.

Conclusions: In this review, no evidence of a relationship between SI and GE was identified for different drugs used for the treatment of gastroparesis. This finding questions the use of GE measurement to direct drug development for gastroparesis.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Cisapride / pharmacology
  • Cisapride / therapeutic use
  • Diabetes Mellitus, Type 2 / complications*
  • Domperidone / pharmacology
  • Domperidone / therapeutic use
  • Erythromycin / pharmacology
  • Erythromycin / therapeutic use
  • Gastric Emptying / drug effects*
  • Gastrointestinal Agents / pharmacology
  • Gastrointestinal Agents / therapeutic use*
  • Gastroparesis / drug therapy*
  • Gastroparesis / etiology
  • Humans
  • Metoclopramide / pharmacology
  • Metoclopramide / therapeutic use
  • Severity of Illness Index
  • Sulpiride / analogs & derivatives
  • Sulpiride / pharmacology
  • Sulpiride / therapeutic use
  • Treatment Outcome


  • Gastrointestinal Agents
  • Domperidone
  • Erythromycin
  • Sulpiride
  • levosulpiride
  • Metoclopramide
  • Cisapride