Dr. Parkman: Gastroparesis remains a challenging syndrome to manage with few effective treatments and a lack of rigorously controlled trials. Tricyclic
antidepressants are often used to treat refractory symptoms of nausea,
vomiting, and abdominal pain.  Evidence from well-designed studies for this
is lacking.

However, in this study, among patients with idiopathic gastroparesis, the
use of nortriptyline compared with placebo for 15 weeks did not result in
improvement in overall symptoms. These findings do not support the use of
nortriptyline for idiopathic gastroparesis.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Parkman: Yes, we expected this might help the symptoms of abdominal pain, nausea, vomiting.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Parkman: This study shows that among patients with idiopathic gastroparesis, the use of nortriptyline compared with placebo for 15 weeks did not result in
improvement in overall symptoms. Our results raise general doubts about the
utility of tricyclic antidepressants in low doses as a strategy for the
treatment of idiopathic gastroparesis.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Parkman:  Other neuromodulators should be assessed in patients with gastroparesis. Specifically, those that target nausea and vomiting.

Citation:

Effect of Nortriptyline on Symptoms of Idiopathic Gastroparesis
The NORIG Randomized Clinical Trial

Parkman HP, Van Natta ML, Abell TL, et al. Effect of Nortriptyline on Symptoms of Idiopathic Gastroparesis: The NORIG Randomized Clinical Trial. JAMA. 2013;310(24):2640-2649. doi:10.1001/jama.2013.282833.