Learn about symptoms and treatment for gastroparesis — a digestive condition that affects muscles in your stomach and prevents it from emptying properly.
Gastroparesis is a condition that affects the normal spontaneous movement of the muscles (motility) in your stomach. Ordinarily, strong muscular contractions propel food through your digestive tract. But if you have gastroparesis, your stomach's motility is slowed down or doesn't work at all, preventing your stomach from emptying properly.
The cause of gastroparesis is usually unknown. Sometimes it's a complication of diabetes, and some people develop gastroparesis after surgery. Certain medications, such as opioid pain relievers, some antidepressants, and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. For people who already have gastroparesis, these medications may make their condition worse.
Gastroparesis can interfere with normal digestion, cause nausea, vomiting and abdominal pain. It can also cause problems with blood sugar levels and nutrition. Although there's no cure for gastroparesis, changes to your diet, along with medication, can offer some relief.
Your stomach is a muscular sac about the size of a small melon that expands when you eat or drink. It holds as much as a gallon (3.8 liters) of food or liquid. Once your stomach breaks down the food, strong muscular contractions known as peristaltic waves push the food toward the pyloric valve. This valve leads to the upper portion of your small intestine, a segment known as the duodenum.
Signs and symptoms of gastroparesis include:
Many people with gastroparesis don't have any noticeable signs and symptoms.
Make an appointment with your doctor if you have any signs or symptoms that worry you.
It's not always clear what leads to gastroparesis, but in some cases it can be caused by damage to a nerve that controls the stomach muscles (vagus nerve).
The vagus nerve helps manage the complex processes in your digestive tract, including signaling the muscles in your stomach to contract and push food into the small intestine. A damaged vagus nerve can't send signals normally to your stomach muscles. This may cause food to remain in your stomach longer, rather than move into your small intestine to be digested.
The vagus nerve and its branches can be damaged by diseases, such as diabetes, or by surgery to the stomach or small intestine.
Factors that can increase your risk of gastroparesis:
Women are more likely to develop gastroparesis than are men.
Gastroparesis can cause several complications, such as:
Doctors use several tests to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include:
To see how fast your stomach empties its contents, one or more of these tests may be recommended:
Scintigraphy. This is the most important test used in making a diagnosis of gastroparesis. It involves eating a light meal, such as eggs and toast, that contains a small amount of radioactive material. A scanner that detects the movement of the radioactive material is placed over your abdomen to monitor the rate at which food leaves your stomach.
You'll need to stop taking any medications that could slow gastric emptying. Ask your doctor if any of your medications might slow your digestion.
This procedure is used to visually examine your upper digestive system — your esophagus, stomach and beginning of the small intestine (duodenum). It uses a tiny camera on the end of a long, flexible tube. This test can also be used to diagnose other conditions, such as peptic ulcer disease or pyloric stenosis, which can have symptoms similar to those of gastroparesis.
This test uses high-frequency sound waves to produce images of structures within your body. Ultrasound can help diagnose whether problems with your gallbladder or your kidneys could be causing your symptoms.
Treating gastroparesis begins with identifying and treating the underlying condition. If diabetes is causing your gastroparesis, your doctor can work with you to help you control it.
Maintaining adequate nutrition is the most important goal in the treatment of gastroparesis. Many people can manage gastroparesis with dietary changes. Your doctor may refer you to a dietitian who can work with you to find foods that are easier for you to digest. This can help you to get enough calories and nutrients from the food you eat.
A dietitian might suggest that you try to:
Ask your dietitian for a comprehensive list of foods recommended for people with gastropareses. Here's a brief list:
Medications to treat gastroparesis may include:
Medications to stimulate the stomach muscles. These medications include metoclopramide (Reglan) and erythromycin. Metoclopramide has a risk of serious side effects. Erythromycin may lose its effectiveness over time, and can cause side effects, such as diarrhea.
A newer medication, domperidone, with fewer side effects, is also available with restricted access.
Some people with gastroparesis may be unable to tolerate any food or liquids. In these situations, doctors may recommend a feeding tube (jejunostomy tube) be placed in the small intestine. Or doctors may recommend a gastric venting tube to help relieve pressure from gastric contents.
Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. The tube is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can't be controlled by any other method. Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest.
Researchers are continuing to investigate new medications to treat gastroparesis.
One example is a new drug in development called Relamorelin. The results of a phase II trial found the drug could speed up gastric emptying and reduce vomiting. The drug is not yet approved in the United States by the Food and Drug Administration (FDA), but a larger clinical trial is currently underway.
A number of new therapies are being tried with the help of endoscopy — a procedure done with a slender tube (endoscope) that's threaded down the esophagus.
One procedure, known as endoscopic pyloromyotomy (gastric peroral endoscopic myotomy, or G-POEM), involves making an incision in the valve or muscular ring between the stomach and small intestine called the pylorus. A channel is then opened from the stomach to the small intestine. This is a relatively recent procedure that shows promise, though additional research is needed.
Another type of endoscopic procedure involves placing a small tube (stent) where the stomach connects to the small intestine (duodenum) to keep this connection open.
In gastric electrical stimulation, a surgically implanted device provides electrical stimulation to the stomach muscles to move food more efficiently. Study results have been mixed. However, the device seems to be most helpful for people with diabetic gastroparesis.
The FDA allows the device to be used under a compassionate use exemption for those who can't control their gastroparesis symptoms with diet changes or medications. However, larger studies are needed.
If you're a smoker, stop. Your gastroparesis symptoms are less likely to improve over time if you keep smoking.
Some complementary and alternative therapies have been used to treat gastroparesis, including acupuncture. Acupuncture involves the insertion of extremely thin needles through your skin at strategic points on your body. During electroacupuncture, a small electrical current is passed through the needles. Studies have shown these treatments may ease gastroparesis symptoms more than a sham treatment.
You're likely to first see your primary care doctor if you have signs and symptoms of gastroparesis. If your doctor suspects you may have gastroparesis, you may be referred to a doctor who specializes in digestive diseases (gastroenterologist). You may also be referred to a dietitian who can help you choose foods that are easier to process.
Because appointments can be brief, it's a good idea to be well-prepared. To prepare, try to:
Your time with your doctor is limited, so preparing a list of questions will help you make the most of your time together. List your questions from most important to least important in case time runs out. For gastroparesis, some basic questions to ask your doctor include:
In addition to the questions that you've prepared, don't hesitate to ask other questions during your appointment.
Your doctor is likely to ask you a number of questions. Being ready to answer them may allow more time later to cover other points you want to address. Your doctor may ask: