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Understanding Gastroparesis

By James M. Stewart, MD

The stomach has three main roles in the body: 1) store and sterilize food prior to digestion; 2) break up and liquefy the food; 3) slowly release food into the intestines at a controlled rate when ready. When any one of these three functions is inhibited, it can cause a great deal of discomfort. When the stomach doesn’t work correctly, it is called gastroparesis.

Gastroparesis is a dysfunction of the nerves and muscles of the stomach. Typical symptoms of gastroparesis include early satiety (feeling full after a few bites of food), nausea and vomiting, bloating, and abdominal pain. These symptoms are very similar to other more common gastrointestinal diseases such as functional dyspepsia, Helicobacter pylori infection, esophagitis, as well as mechanical blockages or inflammation of the esophagus or stomach. Fortunately, in the general population, gastroparesis is rare.

Gastroparesis can be caused by poorly controlled diabetes or surgical complications, as well as being a random occurrence with no known cause. Up to one-third of patients with gastroparesis have no discernable risk factors, although it tends to be slightly more common in young women for unclear reasons.

Diagnosing gastroparesis usually involves a couple of tests to confirm the condition. An upper endoscopy is often performed to look for any mechanical blockages such as large stomach polyps or inflammation in the esophagus which may better explain the symptoms. If the upper endoscopy suggests gastroparesis, a “gastric emptying study” may be ordered. This is a test where food that contains a detectable tracer is eaten and then observed over the course of four hours to see how quickly the tracer leaves the stomach. A healthy stomach can usually move more than 90 percent of food out of the stomach in four hours. If a large amount of food is still detected in the stomach after four hours, it strongly suggests gastroparesis. Certain medications will affect the result of this test so it is important you talk with your physician about what medications you are taking before undergoing this test.

Some medications can also slow the emptying of the stomach and should be avoided, if possible, if gastroparesis is suspected. These include opiate-based pain medications and anticholinergic medications (often are anti-nausea medications or anti-depression medications). If you have gastroparesis, alternative should be found for these medications.

There is no known cure for gastroparesis, but for some people it is a temporary problem that resolves with time. Controlling diabetes is essential in anyone with diabetes-induced gastroparesis. Beyond that, most of the treatment for gastroparesis involves changing how one eats to minimize symptoms. Most patients can get significant improvement in their symptoms if they eat a small volume of food very frequently. It also helps to avoid fatty foods since they delay emptying of the stomach. Liquids should be able to move through the stomach without much trouble. Some colleagues of Granite Peaks GI in Arizona created a handout that reviews the specific dietary recommendations as well as cooking options which can be very helpful:

Medications, such as Reglan, can sometimes reduce symptoms and help the stomach empty faster but these medications aren’t without risk. Your physician will discuss the risks and benefits to using medications for gastroparesis.

For very difficult cases, physicians have tried surgery where the stomach is removed or bypassed as well as something called a gastric stimulator or gastric pacemaker. Unfortunately, neither of these therapies has been shown to be effective enough to recommend for the majority of patients with gastroparesis but if you have any questions about these therapies, please discuss these with your physician.

Learn more about Dr. Stewart or schedule an appointment.

Camilleri M, Parkman HP, Shafi MA, Abell TL, Gerson L; American College of Gastroenterology. Clinical guideline: management of gastroparesis. Am J Gastroenterol. 2013 Jan;108(1):18-37