Is there a particular prokinetic agent that you recommend if a patient has failed both PPI and TCA in the treatment of suspected functional dyspepsia?  

In general, the evidence to support the use of prokinetics in functional dyspepsia (FD) is not strong. The rationale for using a prokinetic agent for FD is to improve gastric emptying time in the subset (about ¼) of patients who delayed gastric emptying which is usually mild. The three prokin...

We frequently perform gastric accommodation SPECT which is abnormal in a subset of patients with FD. These patients have particular benefit from buspirone which induces fundal relaxation. 

There is little evidence to support the use of prokinetics for FD. I do sometimes use them and typically will use Reglan in low doses or motegrity if someone has concomitant constipation.There was a SR in 2019 published in the Am J Gastro (Pittayanon et al., PMID 30337705) that suggested prokin...