You’ve likely experienced feeling really full after eating. For patients with gastroparesis, that full feeling can come quickly, and linger for hours, leading to uncomfortable stomach pain, bloating, acid reflux, and in extreme cases, malnourishment. Learn more about this condition, what causes it, and how it’s treated.
What is gastroparesis?
Gastroparesis is a condition in which the stomach muscles don’t work as they should, leading to slower emptying of the stomach. It may also be referred to as slow gastric emptying. It is considered a chronic digestive disorder best defined as severe nausea, vomiting, bloating, and abdominal pain without mechanical gastric outlet obstruction.
Gastroparesis is generally considered to be underdiagnosed. Diagnosed cases are uncommon—one systematic review of 13 studies found a prevalence of 13.8 to 267.7 per 100,000 adults. Other data has shown gastroparesis patients often have long and costly hospital stays.
What causes gastroparesis?
Roughly one-third of cases of gastroparesis have no known cause. Generally, we find that damage to the vagus nerve, which controls the muscles of the stomach, can lead to weakened muscles and gastroparesis. The nerve can be damaged either by a chronic health condition, such as diabetes, an infection, or as a complication from surgery. Additionally, certain medications such as progesterone, calcium channel blockers, GLP-1 antagonists , as well as narcotics and nicotine can slow down the emptying of the stomach.
What are the symptoms of gastroparesis?
Symptoms of gastroparesis can vary. They can be mild and easily controlled with diet changes, or they can be very severe with an inability to maintain nutrition and threat to life.
Symptoms of gastroparesis include:
- Feeling full soon after you begin eating, and for a long time after a meal
- Vomiting and nausea
- Bloating and belly pain
- Not wanting to eat, weight loss, malnutrition
- Acid reflux
- Changes in blood sugar levels
Another symptom can include the formation of bezoars, which are compact and hard masses of food that get stuck in the stomach. A bezoar may become too large to pass from the stomach and block food from emptying.
However, some patients with gastroparesis are asymptomatic.
How is gastroparesis diagnosed?
A healthcare provider will work with a patient to review their symptoms, medical history, including any procedures or conditions that might cause gastroparesis, and use imaging tests to detect if there is any obstruction. Common tests used when diagnosing gastroparesis include upper endoscopy, a CT scan, MRI, and abdominal ultrasound. A nuclear gastric emptying scan is the gold standard to objectively document gastroparesis.
How is gastroparesis treated?
Unfortunately, there is no cure for gastroparesis. The goal of treatment focuses on symptom control, which often relies on several modalities used in combination.
Dietary changes for gastroparesis
Changing how you eat can help manage the symptoms of gastroparesis and ensure you’re getting the nutrition that you need. Some of these changes or focal points include:
- Drinking plenty of water in steady sips throughout the day. If you’re having difficulties with solid foods, nutritional drinks such as Ensure can help make sure you have the calories and protein your body needs to function. Avoid alcohol, since it slows down stomach emptying.
- Smaller, more frequent meals can give your stomach time to digest and keep you from feeling nauseated.
- Reduce fat and fiber from your diet. Fat and fiber both slow down stomach emptying, so diets high in fat or fiber can contribute to symptoms as well as bezoar formation.
- Eat solid foods earlier in the day, making sure to chew well, and then eat lighter or liquid meals later in the day. Sitting upright while eating and for at least an hour after can help your stomach muscles work. Going for a walk after eating can also increase stomach emptying and reduce symptoms.
- A liquid or chewable multi-vitamin is recommended.
Your care team may also prescribe nutritional therapy to ensure you’re getting the nutrients you need. This may include dietary supplements, IV fluids, or tube or IV feeding.
Medication for gastroparesis
Only one medication is currently FDA-approved for gastroparesis—metoclopramide. This medication activates the stomach muscles to help them work and move food from the stomach to the small intestine. There are some potentially serious side effects with this medication. If you are prescribed metoclopramide, be sure to discuss these thoroughly with your care team.
Other medications that are not FDA-approved specifically for gastroparesis (but are otherwise FDA-approved) include certain antibiotics, such as erythromycin, and serotonin agonists.
Some medications may be prescribed to help manage the symptoms of gastroparesis, including diabetes medications to control blood sugar, antiemetics to control nausea and vomiting, and antacids for overflow reflux. Botox injections into the pylorus (the lower opening of the stomach that connects to the small intestine) may also help temporarily improve symptoms.
Surgery for gastroparesis
If medication and nutritional changes are not enough, surgery is an option to help with gastroparesis.
Several surgical options are currently offered at Brown University Health. The gastric stimulator (also known as Enterra therapy) is approved for idiopathic and diabetic gastroparesis patients with primary symptoms of nausea and vomiting. The stimulator leads are implanted directly into the stomach, and the generator (or battery) is placed in the abdominal wall. This procedure does not alter a patient’s anatomy.
Additional procedures include G-POEM (gastric per-oral endoscopic myotomy) or pyloroplasty. These procedures cut the pylorus muscle at the bottom of the stomach to expand the opening and allow food to pass through more easily. Gastric bypass surgery may also be recommended, especially for severe gastroparesis related to diabetes.
When to talk to your care provider
If you have had stomach pain or bloating, or feeling full quickly and for a long time, for three months or more, talk to your healthcare provider about your symptoms. It can be helpful to keep a record of what you’ve eaten and how you are feeling after. Your provider can discuss any diagnostic tests you may need or refer you to a gastroenterologist or foregut surgeon for further evaluation.
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