Gastroenterology

AGA releases updated gastroparesis management guideline

October 2, 2025

The American Gastroenterological Association’s 2025 guideline outlines 12 conditional recommendations for gastroparesis management, emphasizing individualized care and shared decision-making. It supports the four-hour gastric emptying study for diagnosis and recommends metoclopramide or erythromycin as initial pharmacologic options. Several other agents and procedures are discouraged due to limited evidence or lack of benefit.

Key recommendations

• Use 4-hour gastric emptying scintigraphy for diagnosis; avoid 2-hour testing.
• Initiate treatment with metoclopramide or erythromycin.
• Do not use domperidone, prucalopride, aprepitant, nortriptyline, buspirone, or cannabidiol as first-line agents.
• Reserve gastric per-oral endoscopic pyloromyotomy (G-POEM) and gastric electrical stimulation (GES) for refractory cases.
• Emphasize shared decision-making and recognize ongoing unmet therapeutic needs.

Source:

Staller K, et al; AGA Clinical Guidelines Committee. (2025, October). Gastroenterology. AGA Clinical Practice Guideline on Management of Gastroparesis. https://pubmed.ncbi.nlm.nih.gov/40976635/