The first dedicated AGA guideline arrived. The American Gastroenterological Association published its clinical practice guideline on gastroparesis in Gastroenterology in October 2025, with 12 conditional recommendations. Before it, US clinicians worked mainly from the 2022 American College of Gastroenterology guideline. The new document is stricter on diagnosis and more cautious on procedures. You can read the AGA’s own summary of its gastroparesis recommendations directly.
A new prokinetic cleared Phase 2b. Naronapride met its primary endpoint in MOVE-IT, a 328-patient global Phase 2b trial in adults with moderate to severe idiopathic or diabetic gastroparesis and objective evidence of delayed emptying. Results were announced May 4, 2026. The 20 mg and 40 mg three-times-daily doses beat placebo on nausea, early satiety, postprandial fullness, and upper abdominal pain. On June 1, 2026, Dr. Falk Pharma and Renexxion announced they were advancing into Phase 3 registration studies, with a new drug application to follow those results. Phase 3 has not reported. Naronapride is not available outside a study.
A drug was approved, but not for this. Tradipitant was approved by the FDA on December 30, 2025 under the brand name NEREUS, for the prevention of vomiting induced by motion. That is motion sickness. It is not an approval for gastroparesis.
The confusion is understandable. Tradipitant is an oral NK-1 receptor antagonist, it stops vomiting, and it became commercially available across the US on May 1, 2026 as the first new prescription option for motion sickness in more than 40 years. Patients see “new drug, prevents vomiting” and assume it applies to them.
Here is the part that gets left out. The FDA rejected Vanda’s application for tradipitant in gastroparesis in September 2024, citing a lack of substantial evidence of effectiveness and safety. The company is still developing it for gastroparesis, and separately for nausea and vomiting caused by GLP-1 receptor agonists. Neither of those uses is approved. If someone tells you there’s a newly approved gastroparesis drug, they’re describing a motion sickness approval.
Get the diagnosis right before you consider any procedure
The AGA guideline’s first recommendation is about testing, not treatment: use a 4-hour gastric emptying study, not a 2-hour one.
That isn’t a technicality. Patients whose stomachs look normal at 2 hours can be reclassified as delayed at 4 hours. If your study was cut short, your result may not mean what you were told it meant.
Two other diagnostic points matter as much, and both come up constantly in this practice.
A normal upper endoscopy does not rule out a motility problem. Endoscopy is excellent at finding damage, ulcers, strictures, and inflammation, and it’s necessary to rule out a mechanical blockage. It does not measure how fast your stomach empties. Patients arrive here regularly having been told their endoscopy was clean and nothing more could be done.
And a gastroparesis label given on symptoms alone is not a diagnosis. Nausea, bloating, early fullness, and upper abdominal pain overlap heavily with reflux, functional dyspepsia, esophageal hypersensitivity, and motility disorders such as achalasia, which is treated in an entirely different way. Dr. Grandhige does not recommend a procedure without objective testing that supports it. That principle is why a meaningful share of consultations here end without surgery.
Endoscopic pyloromyotomy (G-POEM): what it does and what it doesn’t
Endoscopic pyloromyotomy, also called G-POEM or POP, is performed entirely through the mouth with a flexible endoscope. A small tunnel is created under the pyloric muscle, the valve at the stomach’s exit, and that muscle is divided from the inside. Less resistance at the outlet means food leaves the stomach more normally. There are no incisions on your abdomen.
Dr. Grandhige performs this procedure himself. Most gastroparesis care in Pinellas County is medical management handled by a general gastroenterologist, and the list of surgeons in the region who perform G-POEM is short.
Two honest limits belong on this page.
G-POEM manages gastroparesis. It does not cure the underlying nerve or muscle problem, and published data show the benefit can lessen over a period of years, so some patients need a repeat procedure or a different approach later. Follow-up is part of the plan, not an afterthought.
The AGA guideline conditionally recommends against the routine initial use of G-POEM and reserves it for selected patients whose symptoms are refractory to medical therapy. Prokinetics and antiemetics come first. That’s already how this practice sequences it, so the guideline changed nothing here. It should change how you read any page presenting G-POEM as a first move.
The other procedures, the evidence behind them, and the order you do things in
Four other procedural options come up. The 2025 guideline treats each one differently, and the differences are worth knowing before anyone recommends one to you.
Pyloric botulinum toxin injection. The AGA suggests against routine use. The supporting evidence is very low quality.
Gastric electrical stimulation (Enterra). The AGA suggests against routine use, on very low quality evidence, while acknowledging that patients who place a high value on possible improvement in nausea and vomiting may reasonably choose it through shared decision-making. Dr. Grandhige does not implant gastric stimulators. If your testing and symptom pattern point that way, he’ll say so and connect you with someone who does.
Surgical pyloromyotomy and pyloroplasty. The AGA issued no recommendation at all, either for or against, and named these as procedures with genuine knowledge gaps. That’s an unusual step for a guideline panel, and it’s a fair thing to raise with any surgeon proposing an open or laparoscopic pyloric operation.
The combination approach. A double-blind randomized trial published in JAMA Network Open on December 9, 2025 tested pyloroplasty plus gastric electrical stimulation against pyloroplasty alone in 38 adults with refractory diabetic or idiopathic gastroparesis at a single US academic motility center. Symptom improvement at 3 months was statistically greater when the stimulator was switched on. When the device was later turned on in the delayed group, their symptoms caught up. You can read the full randomized trial of combined stimulation and pyloroplasty in the journal. It’s a small, single-center study, and it involves two things this practice does not perform. It’s here because it’s real, it’s recent, and it’s where the surgical conversation is heading.
Now the sequencing detail, which is the piece no other page ranking for this in the area currently tells you. The order you do things in can close doors.
EXPEDITE (ClinicalTrials.gov identifier NCT06560307) is a double-blind randomized study of enhanced Enterra device programming, sponsored by Enterra Medical. The University of South Florida in Tampa is listed as an active recruiting site, which makes it the nearest one to Clearwater. Its second exclusion criterion is a history of pyloroplasty, pyloromyotomy, or G-POEM.
Read that again if you’re weighing options. Having G-POEM first disqualifies you from that particular study. The trial also excludes post-surgical gastroparesis, use of GLP-1 receptor agonist medications, narcotic use more than three days a week, and a history of orthostatic intolerance such as POTS. Enrollment is capped at 50 participants across all sites, and it accepts ages 18 to 70 with either idiopathic or diabetic gastroparesis.
None of that means a trial beats a procedure. It means the sequence is a decision, not a default. Trial status changes, so verify the current record on the ClinicalTrials.gov listing for the EXPEDITE study before planning around it. Clearwater itself has hosted gastroparesis drug studies, and recruitment there opens and closes, so check the registry rather than assuming.
How decisions get made here, and how often the answer is no
What the process looks like from Clearwater
Tampa Bay Reflux Institute is at 1315 South Howard Avenue, Suite 101, Tampa, FL 33606, in South Tampa. It’s the yellow brick building next to Sally O’Neill’s Pizza, with parking behind the restaurant. Office hours are 9 a.m. to 6 p.m., Monday through Friday. The phone is 813.922.2920.
From Clearwater you’ll come over the Courtney Campbell Causeway or the Howard Frankland Bridge, roughly a 30 to 40 minute drive depending on route and traffic. All surgical procedures are performed at HCA South Tampa Hospital, where the same operating room team, anesthesia group, and physician assistant work with Dr. Grandhige on every case.
The timeline is structured rather than open-ended. New patients are typically seen within 2 weeks and always within 4. If your testing is already complete, one consultation is usually enough and a procedure can often be scheduled about 4 weeks out. If testing is still needed, expect two visits about 4 weeks apart and roughly 8 weeks total from first consultation to procedure. Insurance authorization runs in parallel and can take 4 to 6 weeks on its own. The office handles that process and completes it before anything is scheduled.
Testing gets consolidated wherever possible, and studies that can be done closer to home in Pinellas are arranged there so you make fewer trips across the bay. Patients elsewhere in the county can also read the gastroparesis page written for St. Petersburg patients, and the full clinical background on the condition lives on the main gastroparesis overview.
After a procedure, Dr. Grandhige’s physician assistant, who assists on every case and has worked with him for over a decade, handles postoperative questions and knows your specific anatomy. Dr. Grandhige is reachable directly after hours.
Frequently asked questions
Find out what your testing actually shows
Bring your records. Send prior endoscopy and pathology reports, any gastric emptying study, motility or pH testing, imaging, and your medication list to info@tampareflux.com before your visit, and Dr. Grandhige will review all of it beforehand so the appointment is spent on explanation and decisions instead of paperwork.
New patients from Clearwater and across Pinellas County are typically seen within two weeks.
An endoscopy cannot tell you if you have reflux. It can only tell you if you have complications of GERD.
If you are unhappy with your reflux symptoms, come in and we can discuss testing and treatments that can accurately diagnose your problem.
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If you have a hiatal hernia and fit one of these categories, you should know your options.
Dr. Grandhige is an expert in his field and performs 200 of these surgeries a year. He is the only surgeon in the Tampa Bay Area who offers all surgical options - LINX, Fundoplications, TIF and will be one of 20 surgeons in America introducing the latest procedure RefluxStop in 2026.
We accept most insurances but will verify yours before you come in. These procedures are considered medically necessary and covered by your insurance. You can expect to pay your in-network deductibles and nothing else.
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What causes reflux ?
1. Weak lower esophageal sphincter
2. Hiatal hernia
3. Flattening of the Angle of His
4. Poor esophageal motility
5. Gastroparesis (slow stomach)
NOT increased acid production
Don’t let GERD get in the way of living your life. Request your appointment with us today on the link below.
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https://tampareflux.com/contact-us/
Anyone can be victim to GERD and though weight loss can help reduce GERD symptoms. Many athletes with high impact workouts may continue to have these symptoms. This may be a symptom of a hiatal hernia or other issue. We are more then happy to assist you in finding your solution, just click the link below.
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Heartburn may seem like an annoyance. But if you find yourself having symptoms on a daily basis, it may be time to to talk to Dr. Grandhige as it could be a symptom of something worse.
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If you are tired of avoiding your favorite foods or taking daily medications, we can help.
We are the Tampa experts in reflux ! With years of experience and thousands of patients treated successfully, we offer all FDA approved anti-reflux procedures.
Call 813-922-2920 to schedule your appointment
All major insurances accepted.
Not all patients need surgical intervention. Many patients are living a heartburn free life with their PPIs. However 40% of patients taking PPIs are not getting the relief they need. If you are one of those, you have options! Come in and find out more.
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