A 45-year-old man with long-standing type 1 diabetes presents with postprandial fullness, nausea, and vomiting of partially digested food eaten hours earlier. Upper GI endoscopy and barium study rule out mechanical obstruction. Gastric emptying scintigraphy shows 65% retention at 4 hours (normal <10%). The FIRST-LINE prokinetic drug of choice is:
- A Metoclopramide ✓
- B Domperidone
- C Erythromycin
- D Cisapride
Correct answer: A. Metoclopramide
Explanation
Metoclopramide (dopamine D2 receptor antagonist) is FDA-approved and guideline-recommended as first-line pharmacological therapy for diabetic gastroparesis. However, long-term use carries the risk of tardive dyskinesia and is restricted to short-term use (<12 weeks). Domperidone (available outside the US) does not cross the BBB and has fewer neurological side-effects. Cisapride was withdrawn due to QTc prolongation. Erythromycin (motilin agonist) is effective but used for severe acute cases.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.