Evidence-Based Management of Gastrointestinal Symptoms

Introduction to Symptom Management

The American Gastroenterological Association recommends ondansetron, promethazine, prochlorperazine, or aprepitant for nausea and vomiting, with prokinetics like metoclopramide, domperidone, erythromycin, or prucalopride added for gastroparesis-related symptoms 1, 2
The American Gastroenterological Association suggests acid-suppressive drugs, such as proton pump inhibitors or H2 receptor antagonists, for epigastric or acid-related pain, and antispasmodics like hyoscyamine, dicyclomine, or peppermint oil for cramping or spasmodic pain 1, 2

The American Gastroenterological Association recommends neuromodulators, including tricyclic antidepressants, SSRIs, SNRIs, pregabalin, or gabapentin, for chronic visceral pain, depending on location, type, and frequency 1, 2
The American Gastroenterological Association advises against using opioids for chronic abdominal pain, as they worsen gastric emptying and risk narcotic bowel syndrome 1, 2, 3

Gastric electrical stimulation may improve refractory nausea and vomiting in carefully selected patients who have failed medical therapy, are not on opioids, and do not have predominant abdominal pain, according to the American Gastroenterological Association 3

For acute undifferentiated nausea/vomiting/abdominal pain, the American Gastroenterological Association recommends starting ondansetron 8mg or promethazine 12.5-25mg for predominant nausea/vomiting, and using a PPI or H2-blocker for predominant epigastric pain 1, 2
For cramping pain, the American Gastroenterological Association suggests adding an antispasmodic like hyoscyamine or dicyclomine 1, 2
The American Gastroenterological Association recommends reassessing at 30-60 minutes and adjusting therapy based on response, and obtaining a gastric emptying study if gastroparesis is suspected 1, 2, 3