A 55-year-old woman with 20 years of type 2 diabetes reports early satiety, postprandial nausea, and vomiting of undigested food eaten hours earlier. Upper gastrointestinal endoscopy shows retained food with no mechanical obstruction. Which drug is the standard first-line prokinetic for her condition?
- A Metoclopramide ✓
- B Cisapride
- C Loperamide
- D Omeprazole
Correct answer: A. Metoclopramide
Explanation
Diabetic autonomic gastroparesis from vagal dysfunction is managed first with dietary modification plus metoclopramide, a dopamine D2 antagonist that enhances gastric fundal relaxation and antral peristalsis, and it is the longest-established approved agent for this indication. Cisapride was withdrawn in most countries because of QT prolongation and fatal arrhythmias. Omeprazole addresses reflux symptoms only and does not improve emptying, and loperamide slows gut transit, acting opposite to what is needed here.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.