What Is Gastroparesis?
You may never have heard of gastroparesis—or delayed gastric emptying—but experts estimate that the condition affects up to 5 million Americans. It can lead to complications like persistent nausea and vomiting, bloating, heartburn, abdominal pain, early satiety, dehydration, malnutrition, and a decrease in the quality of life.
Gastroparesis, which means “paralyzed stomach,” occurs when a person’s stomach takes too long to empty its contents into the small intestine after he or she eats. Most cases of gastroparesis have no known cause, but diabetes is the most common known cause.
Complications from stomach and chest surgeries, such as for weight loss and to repair gastroesophageal reflux disease, are also common causes. Other less common triggers include drugs like anticholinergics and narcotics; viral infections; smooth muscle disorders, such as scleroderma; and metabolic disorders, such as cortisol deficiency or Addison’s disease.
If you’re diagnosed with gastroparesis, your doctor will check that none of your medications are slowing gastric emptying. People with diabetes need to get their blood sugar under good control, since well-controlled sugars can dramatically improve symptoms and help limit nerve damage.
If no trigger or cause is identified, treatment focuses on minimizing symptoms and discomfort and improving nutrition. Your doctor will recommend:
• Grazing. Eat small meals throughout the day instead of larger meals.
• Mashing. Mash food with a fork until it’s soft and well-crushed.
• Chewing. Take time to chew foods well.
• Sitting. Avoid lying down for two to four hours after a meal.
• Limiting. Avoid high-fat and high-fiber foods, although new studies suggest high-fiber foods (fruits and vegetables) mashed well enough may be tolerated.
• Avoiding smoking and carbonated beverages. Smoking delays gastric emptying, and carbonation leads to more bloating.
• Moving. Regular gentle exercise like walking can help improve gut motility and help empty the stomach.
Sometimes, patients tolerate purees and shakes better than regular food.
When dietary changes fail, prescription drugs can be used. Metoclopramide (Reglan) is the only approved prokinetic drug for gastroparesis—it helps speed up gastric emptying. But if taken longer than 12 weeks, side effects can include depression, anxiety, heart-rhythm disorders and, although rare, a neurological movement disorder called tardive dyskinesia.
The antibiotic erythromycin can provide temporary relief by helping increase stomach muscle contractions and improving stomach emptying. Side effects include nausea, vomiting, and abdominal cramps. Antiemetic drugs to reduce nausea and vomiting may be used alone or in combination with other drugs.
In severe cases when patients are resistant to drug therapy, feeding tubes may be considered to bypass the stomach and help nourish patients who’ve lost 10 percent or more of their body weight because of symptoms.
In select cases resistant to drug therapy, gastric electrical stimulation may be considered. Doctors implant a pacemaker-like device in the abdomen, and small wires (leads) in the stomach’s muscular lining. Research suggests that these pulses help calm the nerves and reduce symptoms.
More extreme measures
Surgery is considered a last resort for patients with severe gastroparesis. But a small study appearing in a 2012 issue of the Journal of the American College of Surgeons suggests that a minimally invasive procedure, laparoscopic pyloroplasty, may be an effective treatment for severe gastroparesis in select patients.
The procedure involves widening the pyloric valve where the stomach and the small intestine meet, which enables the stomach to empty faster. Eighty-two percent of patients reported improved symptoms one month after the procedure. More research is needed to determine which patients benefit most.
Doctors at Johns Hopkins University School of Medicine in Baltimore have come up with an innovative approach—a gastric-outlet stent placement—to treat consenting patients with the most severe types of gastroparesis when other methods have failed.
In a study published in 2015 in the journal Gastrointestinal Endoscopy, researchers reported that stent placement dramatically improved symptoms in most of the 30 patients studied.
The researchers noted in particular that stent placement allowed control of symptoms in patients who had been admitted to the hospital with severe symptoms, all of whom were subsequently discharged shortly after stent placement. The study did note, however, that larger numbers of patients would be needed to confirm the findings, ideally in a randomized, placebo-controlled setting.
Gastroparesis has no cure, but the right diet and treatment can reduce symptoms dramatically for most patients. However, people with severe symptoms may find it difficult to tolerate mashed, minced, and pureed foods. Many patients have been on narcotic medications for pain for years, and weaning off the drugs can sometimes improve symptoms right away.
Prokinetics and antinausea drugs should be used with an understanding of their benefits and risks. Safer and better treatments are needed.
The National Institutes of Health Gastroparesis Clinical Research Consortium, comprised of academic medical centers, is pooling its resources to answer basic questions about gastroparesis, and researchers are continuing to study novel drugs and other therapies.