Gastroparesis

Topic Overview

What is gastroparesis?

After a meal, the stomach normally empties in 1½ to 2 hours. When you have gastroparesis, your stomach takes a lot longer to empty. The delay results in bothersome and possibly serious symptoms because digestion is altered.

Bezoar is a fairly rare condition related to gastroparesis. In this condition, food stays in the stomach for a long time and forms a hard lump. This causes food to get stuck in the stomach.

What causes gastroparesis?

Gastroparesis occurs when the nerves to the stomach are damaged or don't work. Diabetes is the most common cause. Other causes include some disorders of the nervous system, such as Parkinson's disease and stroke, and some medicines, such as tricyclic antidepressants, calcium channel blockers, and opioid pain relievers. This condition can also be a complication of gastric surgery.

What are the symptoms?

The most common symptoms of gastroparesis are:

• A feeling of fullness after only a few bites of food.
• Nausea.
• Vomiting.
• Food coming back up your throat, without nausea or vomiting.

Gastroparesis may be suspected in a person with diabetes who has upper digestive tract symptoms or has blood sugar levels that are hard to control. Controlling blood sugar levels may reduce symptoms of gastroparesis.

How is gastroparesis diagnosed?

Your doctor will ask you questions about your symptoms and will do a physical exam. He or she may also need to do tests to check your stomach and digestion and to rule out other problems that may be causing your symptoms. Tests that may be done include:

• Gastric emptying scan. This test can show how quickly food leaves your stomach. A radioactive substance is included in a solid meal that you eat. It does not include enough radiation to harm you. This substance shows up on a special image, allowing a doctor to see food in your stomach and watch how quickly it leaves your stomach.
• Gastric or duodenal manometry. Manometry is a test that measures the strength and pattern of muscle contractions. This test may be done in the stomach (gastric manometry) or in the first part of the intestines (duodenal manometry).
• Upper gastrointestinal series.
• Upper gastrointestinal endoscopy.
• Abdominal ultrasound.
• Blood tests.

How is it treated?

You can make changes to your lifestyle to help relieve your symptoms of gastroparesis. Here are some things to try:

• Change your eating habits:
  • It's best to eat several small meals instead of two or three large meals. You may want to replace some solid meals with liquids (such as soup).
  • After you eat, wait 2 to 3 hours before you lie down.
  • Eat meals that are low in fiber and fat.
  • Relax before you start eating, and then eat slowly.
• If you have diabetes, it's a good idea to:
  • Carry a quick-sugar food that is absorbed in your mouth instead of your stomach (such as glucose tabs, gels, or hard candy) in case you need to treat low blood sugar.
  • Find out if being active speeds up your digestion or slows it down. Having gastroparesis can cause unpredictable changes in blood sugar. The more you know about how your body responds, the better you'll be able to control your diabetes.

If you need help making changes to your diet, ask your doctor or a dietitian for help.

There are also medicines that can help with gastroparesis, including:

• Medicine to help with nausea and vomiting (antiemetics), such as prochlorperazine, trimethobenzamide (Tigan), or promethazine.
• Medicine to help the stomach empty more quickly (motility agents), such as metoclopramide (for example, Reglan) or erythromycin.

Changes to diet and medicines help most people who have gastroparesis. If that doesn't work, your doctor may have to try something else. At first, you may need to try a different medicine or take more than one medicine. Other treatments that have been tried for severe gastroparesis include:

• Surgery to place a feeding tube in the small intestine.
• Injections of botulinum toxin (Botox) into your pylorus (the pylorus separates the stomach from the intestines). There is no good evidence that botulinum toxin helps gastroparesis, and it is not used often.
• Implanting a gastric electric stimulator that can make your stomach work faster. There is no good evidence that this surgery works to help gastroparesis. It is not done very often.