Erythromycin and gastroparesis

Q: Erythromycin improves gastrointestinal motility by mostly acting at? (select one)

A) Gastric fundus

B) Duodenum

C) Jejunum

D) Descending colon

Answer: A

Although not as popular as previously, many clinicians continue to utilize Erythromycin for gastroparesis in inpatient settings. Erythromycin is a motilin agonist and induces high-amplitude gastric propulsive contractions. Erythromycin usually stimulates fundic contractility that inhibits the accommodation response of the proximal stomach after food ingestion. 

Gastroparesis effect can be evident even at very small doses at 40 mg. Erythromycin should not be used more than 250 mg three times daily due to potential side effects. Patients who are not on continuous tube feed in the ICU should be given erythromycin before meals. 

Intravenous Erythromycin is said to be more effective than oral administration.

Potential issues with erythromycin are tachyphylaxis, abdominal pain, ototoxicity (long-term use), bacterial resistance, QT prolongation, and sudden death.

Another utility of erythromycin is to accelerate the transpyloric migration of the tip of an enteral feeding tube, a common issue in ICU.

#nutrition

#pharmacology

#GI

References:

1. Keshavarzian A, Isaac RM. Erythromycin accelerates gastric emptying of indigestible solids and transpyloric migration of the tip of an enteral feeding tube in fasting and fed states. Am J Gastroenterol 1993; 88:193.

2. Bruley des Varannes S, Parys V, Ropert A, et al. Erythromycin enhances fasting and postprandial proximal gastric tone in humans. Gastroenterology 1995; 109:32.

3. Maganti K, Onyemere K, Jones MP. Oral erythromycin and symptomatic relief of gastroparesis: a systematic review. Am J Gastroenterol 2003; 98:259.