Metoclopramide has been the cornerstone of gastroparesis management for the past 40 years as it is the only FDA-approved medication for gastroparesis. Other medications such as erythromycin and domperidone have been used off-label with variable efficacy. Historically, metoclopramide has been used in oral, intravenous, and subcutaneous formulations. It is an antiemetic and prokinetic medication that acts through the inhibition of central (chemoreceptor trigger zone) and peripheral dopaminergic and serotogenic receptors. Due to its antidopaminergic effects, extrapyramidal symptoms have been reported, with the most feared adverse event being tardive dyskinesia. Subsequently, the FDA issued a metoclopramide black box warning label in February 2009 due to its risk of causing tardive dyskinesia, which can be irreversible. The incidence and prevalence of tardive dyskinesia among metoclopramide users have been variable in different studies. However, upon review of the current literature, the true prevalence of tardive dyskinesia seems to be lower than previously thought. This review will focus on metoclopramide and the extrapyramidal symptoms associated with its use.

Common variable immunodeficiency (CVID) is characterized by defective immunoglobulin synthesis because of impaired B-cell function. Liver abnormalities including autoimmune hepatitis (AIH) have been described in up to 10% of patients. We report a 27-year-old woman with CVID who presented with liver dysfunction secondary to AIH. AIH is both uncommon and challenging diagnostically in patients with CVID because they have low IgG levels and often have low or undetectable autoantibody levels. Liver biopsy and response to therapy play an important role in establishing the diagnosis. Corticosteroids are the mainstay of therapy, with or without immune modulators.

Background: Gastric per oral endoscopic myotomy (GPOEM) was developed as a therapeutic option for gastroparesis after the pylorus was identified as a key target for gastroparesis management. This study includes a systematic literature review of studies in which GPOEM was utilized as therapy for gastroparesis. Methods: A literature search was conducted in three databases (MEDLINE, Scopus and Embase) of articles that included the keywords “GPOEM”, “Gastric per oral endoscopy myotomy” or “per oral pyloromyotomy” and “Gastroparesis” in the abstract or title. The search covered articles published until 29 February 2020. Results: A total of 139 articles were identified. Only 15 articles met the final inclusion criteria and were retrieved for qualitative data synthesis. Conclusion: GPOEM for gastroparesis is shown to have a high success rate among the studies but data interpretations are limited because of small sample sizes and short follow-up. Subjective and objective data prior to and post-GPOEM will be mandatory to establish credibility. The procedure is technically feasible and safe based on the limited studies available.