Aliment Pharmacol Ther 2011; 33: 679–688

Background  Limited therapeutic options exist for severe gastroparesis, where severe nausea and vomiting can lead to weight loss, dehydration and malnutrition due to inadequate caloric and fluid intake. TZP‐101 (ulimorelin) is a ghrelin receptor agonist that accelerates gastric emptying and improves upper gastrointestinal symptoms in diabetic patients with gastroparesis.

Aim  To assess effects of TZP‐101 in diabetic gastroparesis patients with severe nausea/vomiting and baseline severity scores of ≥3.5 (range: 0–5) on the Gastroparesis Cardinal Symptom Index (GCSI) Nausea/Vomiting subscale.

Methods  Patients were hospitalised and received four single daily 30‐min infusions of one of six TZP‐101 doses (range 20–600 μg/kg) or placebo. Efficacy was assessed by symptom improvement.

Results  At baseline, 23 patients had a mean severity score for GCSI Nausea/Vomiting of 4.45 ± 0.44. Statistically significant improvements over placebo occurred in the 80 μg/kg group for end of treatment changes from baseline in GCSI Nausea/Vomiting subscale (reduction in score of −3.82 ± 0.76, P = 0.011) and the GCSI Total score (−3.14 ± 0.78, P = 0.016) and were maintained at the 30‐day follow‐up assessment (−2.02 ± 1.63, P = 0.073 and −1.99 ± 1.33, P = 0.032 respectively). The proportion of days with vomiting was reduced significantly (P = 0.05) in the 80 μg/kg group (mean of 1.2 days of vomiting for four treatment days) compared with placebo (mean of 3.2 days of vomiting across 4 treatment days).

Conclusions  TZP‐101 substantially reduced the frequency and severity of nausea and vomiting as well as overall gastroparesis symptoms. The results are consistent with gastrointestinal motility effects of TZP‐101, supporting further investigation of TZP‐101 in the management of severe gastroparesis.