Randomized Controlled Double‐blind Trial Comparing Haloperidol Combined With Conventional Therapy to Conventional Therapy Alone in Patients With Symptomatic Gastroparesis

Roldan, Carlos J.; Chambers, Kimberly A.; Paniagua, Linda; Patel, S.D.; Cardenas‐Turanzas, Marylou; Chathampally, Yashwant

doi:10.1111/acem.13245

Cited by 34 publications

(40 citation statements)

References 24 publications

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“…If these results are confirmed, mirtazapine would find an indication in patients with weight and appetite loss. In severely ill patients with gastroparesis seen in the emergency department, intravenous haloperidol decreased abdominal pain and nausea 137…”

Section: Introductionmentioning

confidence: 94%

Gastroparesis: a turning point in understanding and treatment

Grover

Farrugia

Stanghellini

2019

Gut

192

219

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Gastroparesis is defined by delayed gastric emptying (GE) and symptoms of nausea, vomiting, bloating, postprandial fullness, early satiety and abdominal pain. Most common aetiologies include diabetes, postsurgical and postinfectious, but in many cases it is idiopathic. Clinical presentation and natural history vary by the aetiology. There is significant morbidity and healthcare utilisation associated with gastroparesis. Mechanistic studies from diabetic animal models of delayed GE as well as human full-thickness biopsies have significantly advanced our understanding of this disorder. An innate immune dysregulation and injury to the interstitial cells of Cajal and other components of the enteric nervous system through paracrine and oxidative stress mediators is likely central to the pathogenesis of gastroparesis. Scintigraphy and 13C breath testing provide the most validated assessment of GE. The stagnant gastroparesis therapeutic landscape is likely to soon see significant changes. Relatively newer treatment strategies include antiemetics (aprepitant), prokinetics (prucalopride, relamorelin) and fundic relaxants (acotiamide, buspirone). Endoscopic pyloromyotomy appears promising over the short term, especially for symptoms of nausea and vomiting. Further controlled trials and identification of the appropriate subgroup with pyloric dysfunction and assessment of long-term outcomes are essential. This review highlights the clinical presentation, diagnosis, mechanisms and treatment advancements for gastroparesis.

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Section: Introductionmentioning

confidence: 94%

Gastroparesis: a turning point in understanding and treatment

Grover

Farrugia

Stanghellini

2019

Gut

192

219

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“…Benevides et al evaluated the role of combination of haloperidol, dexamethasone, and ondansetron on nausea and pain intensity and morphine consumption after laparoscopic sleeve gastrectomy [8]. Other studies have found haloperidol is effective for the management of gastroparesis [9,10]. Droperidol, a closely related medication, has a morphine-sparing effect when co-administered with morphine via patient-controlled analgesia (PCA) for postoperative pain management [11], and epidural tramadol in combination with droperidol prolonged the duration of analgesia with better antiemetic properties [12].…”

Section: Discussionmentioning

confidence: 99%

Does administration of haloperidol or ketorolac decrease opioid administration for abdominal pain patients? A retrospective study

Heard

Bebarta

Hoppe

et al. 2020

The American Journal of Emergency Medicine

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Background: Haloperidol and ketorolac have been recommended as therapies that may decrease opioid use for treatment of pain in emergency department patients. The objective of our study is to determine if administration of haloperidol or ketorolac is associated with lower use of i.v. opioids for patients with non-specific abdominal pain. Methods: A retrospective cohort study of adults (Age 18-60) with non-specific abdominal pain presenting to an emergency department in a large healthcare system. Cases were identified using ICD-10 codes and variables were abstracted from electronic health records. The association between administration of haloperidol or ketorolac with 1) any i.v. opioid administration and 2) receiving >1 dose of i.v. opioids were measured using adjusted odds ratios (AOR) from nominal logistic regression. The model included potential confounders related to both opioid and ketorolac or haloperidol administration. Results: Of 11,688 patients 4091 received one or more doses of an i.v. opioid, 240 received haloperidol and 1788 received ketorolac. The majority of patients were women (67%) and the median age was 32 years. Odds ratios were adjusted for variables associated with opioids, ketorolac or haloperidol use. Haloperidol was not associated with decreased i.v. opioid use (AOR for receiving iv opioids 2.0, 95% CI 1.5 to 2.6) or a lower odds of reciving >1 dose of (AOR 2.0, 95% CI 1.3 to 3.1). Ketorolac was associated with a modest decrease in i.v. opioid use (AOR 0.84 95% CI.0.76 to 0.94 for receiving iv opioids) and a modest decrease for receiving multiple dose of iv opioids (AOR0.79 95% CI 0.63 to 0.99). Conclusions: Haloperidol was not associated with decreased i.v. opioid use. Ketorolac was associated with a modest decrease in i.v. opioid use. Providers should consider the use of

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“…The dose was robust (5 mg). 8 A second randomized trial of haloperidol for gastroparesis published this year was positive. 9 Therefore, haloperidol may be worth pursuing in a trial of opioid-related nausea (specifically in the case of nausea related to gastroparesis).…”

Section: Impact Of Prognostic Discussion On the Patient-physician Rementioning

confidence: 99%

“…Several commentators criticized this article for emphasizing the parents' rights in PDM over their responsibility to support the child's best interests and give voice to the child's views. [4][5][6]8 To turn the authors' position on its head: as providers, shouldn't we prioritize the child's interests unless it is harmful to the parents?…”

mentioning

confidence: 99%

Pc-Facs

Bernard¹

2018

Journal of Pain and Symptom Management

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PC-FACS (Fast Article Critical Summaries for Clinicians in Palliative Care) provides hospice and palliative care clinicians with concise summaries of the most important findings from more than 100 medical and scientific journals. If you have colleagues who would benefit from receiving PC-FACS, please encourage them to join the AAHPM at aahpm.org. Comments from readers are welcomed at pc-facs@aahpm.org.

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Randomized Controlled Double‐blind Trial Comparing Haloperidol Combined With Conventional Therapy to Conventional Therapy Alone in Patients With Symptomatic Gastroparesis

Abstract: Haloperidol as an adjunctive therapy is superior to placebo for acute gastroparesis symptoms.

Cited by 34 publications

References 24 publications

Gastroparesis: a turning point in understanding and treatment

Gastroparesis: a turning point in understanding and treatment

Does administration of haloperidol or ketorolac decrease opioid administration for abdominal pain patients? A retrospective study

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