McCallum RW, Brown RL
University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, Kansas 66160.
Curr Treat Options Gastroenterol. 1998 Dec;1(1):1-7. doi: 10.1007/s11938-998-0001-2.
Nutritional support is essential in treating patients with gastroparesis. Initially, dietary changes should be instituted to reduce extra fat and bulk, and patients should be encouraged to eat frequent small meals with liquid supplementation. Enteral feeding should be introduced in the event of weight loss or persistent vomiting. Medical therapy is usually necessary early in treatment. Cisapride is the initial agent of choice and may be combined with an antiemetic agent, such as promethazine or chlorpromazine or, if side effects occur, ondansetron and granesitron. If cisapride is ineffective or contraindicated, metoclopramide is a reasonable option, though limited by side effects. Erythromycin is useful in the acute treatment of postoperative ileus and hospitalized gastroparetic patients, but its role is limited based on concerns about poor long-term effectiveness and antimicrobial resistance. Once domperidone becomes available in the United States, it will be useful for its promotility and antiemetic qualities. Combination therapy should be considered if monotherapy with cisapride or metoclopramide alone is ineffective. While not yet well studied, combination therapy has the potential to offer dramatic benefit for patients with refractory gastroparesis. Metoclopramide may be added to cisapride for patients with breakthrough symptoms or refractory chronic symptoms. Other combinations include metoclopramide with erythromycin, domperidone with cisapride, and domperidone with erythromycin. In the future, gastric pacing may become an effective option for patients not responding to medical therapy. Total gastrectomy should be performed only for end-stage gastroparesis when all other therapy has failed. Both procedures should be reserved for centers that specialize in severe gastric motility disorders.
营养支持对于治疗胃轻瘫患者至关重要。起初，应调整饮食以减少多余脂肪和食物量，鼓励患者少食多餐并补充液体。若出现体重减轻或持续呕吐，则应采用肠内喂养。治疗早期通常需要药物治疗。西沙必利是首选的初始药物，可与止吐药联合使用，如异丙嗪或氯丙嗪，若出现副作用，则可使用昂丹司琼和格拉司琼。若西沙必利无效或禁忌使用，甲氧氯普胺是一个合理选择，不过会受副作用限制。红霉素对术后肠梗阻和住院胃轻瘫患者的急性治疗有用，但鉴于对其长期疗效不佳和抗菌耐药性的担忧，其作用有限。一旦多潘立酮在美国上市，因其促动力和止吐特性将很有用。若单独使用西沙必利或甲氧氯普胺单药治疗无效，则应考虑联合治疗。虽然尚未得到充分研究，但联合治疗有可能为难治性胃轻瘫患者带来显著益处。对于出现突破性症状或难治性慢性症状的患者，可在西沙必利基础上加用甲氧氯普胺。其他联合用药包括甲氧氯普胺与红霉素、多潘立酮与西沙必利以及多潘立酮与红霉素。未来，胃起搏可能成为对药物治疗无反应患者的有效选择。仅在所有其他治疗均失败的终末期胃轻瘫患者中才应进行全胃切除术。这两种手术都应保留给专门治疗严重胃动力障碍的中心。
