Short-Course, Low-Dose Metoclopramide as Bridge Therapy for Dysautonomia-Associated Gastrointestinal Dysmotility in Adolescents: A Case Series
Abstract
Background: Dysautonomia, including postural orthostatic tachycardia syndrome (POTS) and related orthostatic disorders, is frequently associated with debilitating gastrointestinal (GI) symptoms in adolescents, including chronic nausea, early satiety, postprandial fullness, and functional dysmotility. Despite the significant disease burden, pharmacological options for GI dysmotility in this population remain poorly studied. To our knowledge, no prior case series has described metoclopramide as a targeted prokinetic bridge therapy specifically in adolescents with dysautonomia-associated GI dysmotility symptoms.
Case series summary: We describe three adolescent females (ages 13, 16, and 16 years) with specialist-confirmed dysautonomia and refractory GI symptoms who were treated with a standardized short-course, low-dose metoclopramide bridge protocol (5 mg three times daily, tapered over approximately 12 weeks). All patients received concurrent multidisciplinary management including dietary modification, neuromodulators, integrative therapies, and behavioral support. All three demonstrated subjective improvement in nausea and GI symptoms, enabling engagement with broader rehabilitative and nutritional interventions. No extrapyramidal symptoms or serious adverse effects were observed. Cumulative metoclopramide doses across all three cases ranged from approximately 770 to 1050 mg-well below the threshold associated with tardive dyskinesia risk in contemporary real-world data.…
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Evidence Hub reads this as a case series, done in people. Its evidence level is 5 of 5 (Very low · case / narrative / animal / in vitro / in silico). Case reports, narrative reviews, and animal, cell or computer-model studies give the weakest evidence for human health.
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