Treating Gastroparesis In Clearwater, FL

Pyloromyotomy works well in selected patients and modestly at best in unselected ones. The gap between those two sentences is larger than most pages admit.

An international prospective trial ran the procedure across five tertiary centers in patients with refractory gastroparesis without tight selection. Of 80 enrolled, 75 completed 12 months. Clinical success was 56%, and the authors wrote plainly that unselective use of the procedure should be discouraged. In the same body of work, the predictors of success at one year were a baseline retention above 20% at four hours, a higher baseline symptom score, and an early response at one month.

Compare that to a randomized sham-controlled trial published in Gut in patients with severe, refractory disease. Treatment success at six months was 71% after pyloromyotomy against 22% after a sham procedure. Median retention at four hours dropped from 22% to 12% in the treated group and didn’t move after sham.

Cause matters too. In that trial, success ran highest in diabetic gastroparesis, lower in idiopathic disease, and lowest in post-surgical gastroparesis. Those subgroups were small and the confidence intervals were wide, so treat them as direction rather than a promise. Still, the direction is worth knowing before you drive across the bay: if your gastroparesis followed a prior operation, expectations get set differently from the start.

The AGA’s own position is that pyloromyotomy and gastric electrical stimulation should not be used routinely, even in patients who have failed medical therapy, and should be reserved for selected patients. The role of surgical pyloromyotomy and pyloroplasty was labeled an outright knowledge gap, with no recommendation issued either way. Nobody should present any of this as settled. The numbers above are from published series, not from this practice’s records.

Two things shifted, and both affect what happens at your next appointment.

The AGA published its first gastroparesis-specific practice guideline in October 2025: twelve recommendations, every one of them conditional. Four-hour emptying testing is in and 2-hour testing is out. Metoclopramide or erythromycin remains the starting point, with metoclopramide still the only drug FDA-approved for the condition. Domperidone, prucalopride, aprepitant, nortriptyline, buspirone and cannabidiol all drew recommendations against use as first-line therapy. Pyloromyotomy, gastric electrical stimulation and pyloric botulinum toxin were pushed out of routine use. The overall direction is tighter diagnosis and more conservative procedural use, which is a meaningful change from the 2022 ACG guidance many Tampa Bay physicians were still working from.

The drug pipeline moved as well. Naronapride, an oral prokinetic, completed a global Phase 2b trial in 328 adults with moderate to severe idiopathic or diabetic gastroparesis. The 20 mg and 40 mg three-times-daily doses beat placebo on the ANMS gastroparesis cardinal symptom diary score, with p values of 0.0046 and 0.0156, and improvement showed across nausea, early satiety, postprandial fullness and upper abdominal pain. Results were presented at Digestive Disease Week in May 2026, and on June 1, 2026 the sponsors announced they’re advancing into Phase 3 studies with a US new drug application planned off those results. The MOVE-IT trial record is closed to enrollment.

What that means for you, plainly: naronapride is not available, no approval date exists, and it is not a reason to postpone getting a correct diagnosis. If you want to be considered for a trial in the meantime, ClinicalTrials.gov is the registry to search, and enrollment status at any given site changes week to week, so verify by phone before you drive anywhere.

Gopal Grandhige, MD, FACS is a board-certified general surgeon who has practiced foregut surgery in Tampa Bay since 2009. He trained at Johns Hopkins, the University of Michigan medical school, and Yale New Haven Hospital, where he completed general surgery residency plus fellowships in burn and critical care and in foregut and minimally invasive surgery. He is a Fellow of the American College of Surgeons, a member of SAGES, and a founding member of the American Foregut Society.

His practice is limited to benign disease of the esophagus, diaphragm and stomach. He does not treat esophageal or gastric cancer. Board certification can be verified through the American Board of Surgery physician lookup and licensure through the Florida Department of Health’s license verification tool, and you should check both for any surgeon you’re considering.

Volume in the reflux half of the practice is public: more than 600 fundoplications, more than 600 LINX implants and more than 200 TIF procedures. For gastroparesis specifically, he is one of a small number of surgeons performing per-oral pyloromyotomy in Tampa Bay. The office team includes medical assistants who have worked with him for over a decade and answer clinical questions directly rather than routing them. More detail on his background is on the about the practice page.

The practice holds a 4.9 star average across 37 Google reviews as of August 2026. Most of those reviewers came in for reflux rather than gastroparesis, so read them for how the practice operates, not as evidence about pyloric procedures.

Tampa Bay Reflux Institute, 1315 S Howard Avenue, Suite 101, Tampa, FL 33606. Phone 813-922-2920. The office is in the yellow brick building next to Sally O’Neill’s Pizza, with parking behind the restaurant.