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Almost nothing compares to a tasty meal. That is unless every tasty meal makes you sick. Patients with gastroparesis, or “stomach paralysis,” approach every meal as a possible source of pain, nausea, vomiting, and bloating. Gastroparesis, though not curable, can be tamed. It will take some effort, though; treatment requires a commitment to lifestyle changes and may involve medications or surgery to be brought under control.
What is gastroparesis?
Gastroparesis is an inability of the stomach to properly empty its contents after a meal. The stomach’s job is to grind up foods into small particles and send those small bits into the small intestine for final digestion and absorption. Problems with nerves or stomach cells responsible for making stomach muscles contract can slow down the movement of food through the stomach. The result can be nausea, vomiting, bloating, fullness, and pain.
Stomach muscle contractions involve a complex relationship between the central nervous system, autonomic (involuntary) nervous system, stomach nerves, and stomach cells, so gastric (stomach) emptying can go wrong for many different reasons. While almost half of all cases of gastroparesis have no identifiable cause—called idiopathic gastroparesis—gastroparesis can be caused by
- Diabetes. About 30% of gastroparesis is attributed to nerve damage caused by uncontrolled blood sugar, usually in patients with type I diabetes.
- Surgery. About 10% of cases are due to bariatric surgery, gastroesophageal reflux surgery, and other stomach, esophageal, or pancreatic surgeries.
- Neurological conditions such as stress, Parkinson’s disease, or multiple sclerosis.
- Autoimmune conditions such as amyloidosis or scleroderma.
- Viral infections such as rotavirus or Norwalk virus infections.
- Medications can cause gastroparesis as a side effect; these include opioids, tricyclic antidepressants, calcium channel blockers (blood pressure medications), antipsychotics, some diabetes drugs, progesterone, and lithium.
Gastroparesis is more than a nuisance or discomfort. Significant complications such as dehydration, malnutrition, involuntary weight loss, bacterial infections, spikes in blood sugar, and blockage caused by hardened lumps of undigested food (bezoars) can be serious and even life-threatening. Also, patients with gastroparesis have a lower quality of life and a higher mortality rate than other people. Severe cases can be debilitating.
Gastroparesis is a rare condition. About 24 in every 100,000 people have gastroparesis, and women are three times more likely to have the condition than men. A large number of people with the condition go undiagnosed.
How is gastroparesis diagnosed?
A diagnosis of gastroparesis requires the presence of common gastroparesis symptoms, objective evidence of delayed gastric emptying, and the absence of any obstruction or blockage. Diagnosis, then, requires a patient’s history of symptoms, gastric emptying tests, imaging, and an endoscopic examination of the esophagus and stomach.
The most common symptoms of gastroparesis are:
- Chronic nausea
- Vomiting
- Early satiety
- Fullness after a meal
- Bloating
- Abdominal pain
- Acid reflex
- Changes in blood sugar levels
A gastroenterologist (digestive system doctor) will perform an endoscopic examination to find any possible blockage or obstruction. An endoscope is a long, flexible tube with a camera and light at the end. It is inserted into the mouth and threaded down the esophagus into the stomach. The doctor can view the esophagus, stomach, and pylorus— the opening between the stomach and small intestine—on a video monitor. The gastroenterologist may also perform a barium X-ray, CT scan, or MRI to identify possible obstructions.
Once a blockage has been ruled out, the gastroenterologist will measure how quickly food passes through the stomach using a gastric emptying study (GES) employing scintigraphy. Patients are fed a standard meal with traces of a radioactive element (technetium 99). As the food passes through the stomach, a special camera, called a scintillation camera, can measure how quickly the food passes through the stomach. If a certain percentage of the meal is still present after four hours, then a diagnosis of gastroparesis is made.
For patients who cannot undergo a gastric emptying test, other tests include swallowing a monitoring device, called a gastrointestinal monitoring capsule, that can record how long it takes to move from the stomach into the small intestine. Carbon breath testing utilizing a radioactive form of carbon (carbon 13) is a third possible test for measuring gastric motility.
Gastroparesis treatment options
The treatment of gastroparesis focuses on correcting nutritional problems, reducing symptoms, and treating the underlying cause.
Underlying condition
The underlying condition must be managed. In some cases, treating the underlying condition may cure the problem, such as discontinuing a problem drug. Diabetic gastroparesis will be treated first and foremost by bringing blood sugar under control, but the nerve damage and the resulting gastroparesis may be permanent. Some underlying conditions only cause temporary gastroparesis. For instance, some surgeries, such as bariatric surgery or esophageal reflux surgery, produce gastroparesis in nearly all patients, but the condition usually passes within a year. However, if surgery involves significant damage to the vagus nerve—the primary connection between the brain and the stomach—gastroparesis may be permanent.
Diet
The first-line treatment for gastroparesis is to make dietary changes to correct nutritional deficiencies and reduce symptoms. Patients will be asked to eat small, highly nutritious meals four to six times a day. Fats and fibers will be reduced because they slow down gastric motility. Dietary supplements and high-calorie liquids may also be included. Severe cases may require a total liquid diet.
Feeding tubes
If a patient cannot tolerate any oral nutrition, a nasojejunal feeding tube will be tried. The tube is inserted into the nose, down the esophagus, through the stomach, and into the small intestine. Nutrients are sent through the tube directly into the small intestine (jejunum). If this doesn’t work, a surgeon will cut a hole in the abdomen to thread a nutrition tube directly into the stomach (venting gastrostomy) or small intestine (jejunostomy tube). Parenteral nutrition, in which nutrients are injected directly into the bloodstream, is used only as a last resort.
Medications
Medications may be prescribed to improve symptoms. Prokinetic medications such as metoclopramide or erythromycin speed up muscle contractions in the stomach to assist gastric emptying. Antiemetics (anti-nausea drugs) as a second-line treatment to reduce the symptoms of nausea and vomiting.
Gastric electrical stimulation (GES)
When medications fail to improve symptoms, a gastroenterologist may implant a gastric electrical stimulator. Sometimes called a “stomach pacemaker,” the device sends electrical pulses to electrodes attached to the stomach to increase muscle contractions. Nearly all patients with a GES device experience symptom improvements and a reduced risk of complications.
Surgery
When medications fail to sufficiently improve symptoms, a gastroenterologist may turn to surgery, but only for rare cases. Surgical procedures for gastroparesis include
- Botulinum toxin injection. Botulinum toxin, better known as Botox, kills nerves. A gastroenterology surgeon uses an endoscope to inject botulinum toxin into the pylorus sphincter, the tight muscle that controls the opening between the stomach and the small intestine. Nerve death causes the pylorus sphincter to relax and the opening between the stomach and intestine grows wider, allowing food to move more easily out of the stomach.
- Pyloroplasty. Performed with a long flexible tube, called a laparoscope, inserted through an opening in the abdomen, the surgeon cuts the pylorus to make it wider, making it easier for stomach contents to pass into the small intestine.
- Gastrectomy. Part or all of the stomach is removed—including the pylorus—so that food passes from the esophagus directly into the small bowel.
Gastroparesis medications
Medications that treat gastroparesis either increase stomach muscle contractions (prokinetic agents) or reduce nausea (antiemetics).
Prokinetic agents
Prokinetics are drugs that increase the strength or frequency of smooth muscle contractions. Metoclopramide is the first-line drug prescribed for gastroparesis and is given as an injection, tablet, or liquid. It has potentially severe side effects, so drugs such as domperidone or tegaserod may be prescribed instead. Domperidone, however, is only available in select pharmacies in the United States.
Macrolide antibiotics
Normally used to fight off bacterial infections, macrolide antibiotics also have prokinetic effects. Intravenous or oral erythromycin is the first drug used if prokinetics don’t improve symptoms. Erythromycin, though, has potentially severe side effects, so some gastroenterologists use azithromycin, instead.
Antiemetics
As a second-line medical therapy, doctors will turn to drugs that reduce symptoms of nausea, called antiemetics. The most commonly prescribed are antihistamines (promethazine or meclizine), phenothiazines (prochlorperazine or perphenazine), and medications that block serotonin receptors (ondansetron or granisetron). All these drugs block the action of chemicals that pass signals between nerves in the brain. As a result, they partially shut down the brain’s “nausea center,” the area of the brain that produces both the feeling of nausea and the vomiting reflex.
What is the best medication for gastroparesis?
Medications are only one part of treating gastroparesis. Because gastroparesis has many causes, the effectiveness of individual types of drugs in improving symptoms will vary. Many of these drugs have potentially hazardous side effects, so there is no “best” medication for gastroparesis, only the drug that best controls symptoms without the least burdensome side effects.
| Best medications for gastroparesis | ||||
|---|---|---|---|---|
| Drug Name | Drug Class | Administration Route | Standard Dosage | Common Side Effects |
| Reglan (metoclopramide) | Prokinetic | Oral | One 10 mg tablet taken 30 minutes before each meal and at bedtime for two to eight weeks | Restlessness, drowsiness, fatigue |
| Zelnorm (tegaserod) | Prokinetic | Oral | One 6 mg tablet taken twice daily 30 minutes before a meal | Headache, abdominal pain, nausea |
| Ery-Tab (erythromycin) | Macrolide antibiotic | Intravenous injection or oral | One-half to one 500 mg tablet per day | Nausea, vomiting, abdominal pain |
| Promethazine | Antihistamine (antiemetic) | Oral | One 25 mg tablet every 4 to 6 hours | Drowsiness, dry mouth, ringing in the ears |
| Antivert (meclizine) | H1 histamine antagonist (antiemetic) | Oral | One to four 25 mg tablets in divided doses daily | Drowsiness, dry mouth, headache |
| Compazine (prochlorperazine) | Antipsychotic (antiemetic) | Oral or rectal | One 5 mg or 10 mg tablet three to four times daily | Restlessness, blurred vision, dry mouth |
| Zofran (ondansetron) | 5-HT3 receptor antagonist (antiemetic) | Oral | Two 4 mg tablets every 12 hours | Headache, drowsiness, lightheadedness |
| Sancuso (granisetron) | 5-HT3 receptor antagonist (antiemetic) | Transdermal patch | One patch worn for seven days | Constipation, drowsiness, diarrhea |
Many of the standard dosages above are from the U.S. Food and Drug Administration (FDA) and the National Institutes of Health (NIH). Dosage is determined by your doctor based on your medical condition, response to treatment, age, and weight. Other possible side effects exist. This is not a complete list.
What are the common side effects of gastroparesis medication?
Gastroparesis medications will vary in their side effects depending on the medication, the dose, and the patient’s other medical conditions. This is not a complete list, so please consult with a health care provider about your concerns or questions about possible side effects.
Prokinetics work by changing the nervous system, so common side effects include fatigue, drowsiness, sedation, anxiety, and restlessness. All prokinetics can alter heartbeats, a serious and potentially lethal condition called QT prolongation or long QT syndrome.
Unlike domperidone (restricted in the U.S.), metoclopramide can also produce serious neurological damage including tardive dyskinesia (repetitive, involuntary movements such as eye blinking or uncontrolled grimacing), akathisia (a constant, irresistible urge to continually move and fidget), and involuntary muscle contractions that can sometimes affect the entire body. These side effects can persist even after the drug is discontinued.
Macrolide antibiotics commonly cause nausea, vomiting, diarrhea, and abdominal pain. Like prokinetics, macrolide antibiotics can change the way the heart beats (QT prolongation). For cardiac effects, erythromycin is the riskiest macrolide and has been implicated in sudden heart attack death. In addition, the prokinetic effects of erythromycin quickly wear off, so the drug will not be given for gastroparesis for longer than four weeks. Patients with cardiac issues may be put on azithromycin instead, the least risky of the macrolide antibiotics.
For antiemetics, side effects will depend on the type of drug prescribed. However, except for ondansetron and related drugs, antiemetics work by slowing down the brain, so drowsiness, dizziness, sedation, nervousness, and agitation are frequently experienced.
Antiemetics can also cause dry mouth, nausea, and vomiting. Like prokinetic agents, all antiemetics can change the way the heart beats (QT prolongation) when taken over a long period. The risk is lowest with antihistamines and highest with drugs like ondansetron or granisetron.
What is the best home remedy for gastroparesis?
Gastroparesis is a life-changing condition. While it may not be curable, it can be successfully managed with dietary and lifestyle changes.
Eat small meals
Rather than two or three large meals, eat four to six small meals throughout the day to avoid overfilling the stomach.
Chew food thoroughly
Chew food slowly and thoroughly. If that doesn’t improve the symptoms, try pureeing solid food before eating it.
Avoid fatty foods and fiber
Fatty foods and fiber slow down gastric emptying. Red meat, pork, dairy, raw vegetables, raw fruit, and high-fiber foods worsen gastroparesis symptoms.
Avoid carbonated drinks, coffee, or alcohol
Carbonated drinks, coffee, and alcohol will make gastroparesis worse.
Walk after eating
Take a walk one or two hours after eating. Walking helps the stomach to empty its contents.
Chew gum
Chewing gum is one of the best-kept secrets for managing gastroparesis symptoms. The extra saliva stimulated by the gum promotes gastric motility, so pull out a few sticks of gum to chew for one or two hours after a meal.
Quit smoking
Smoking causes a host of digestive tract problems and will worsen gastroparesis symptoms. It’s always a great idea to quit smoking, so gastroparesis is as good a reason as any to say goodbye to tobacco.
Frequently asked questions about gastroparesis
Can gastroparesis be reversed?
Gastroparesis can be a chronic, lifelong condition that cannot be cured or reversed. However, some cases of gastroparesis may be temporary. Gastroparesis due to surgery or medications will often resolve over time or after the medications have been discontinued.
What is the treatment of gastroparesis in people with diabetes?
Diabetes is a common cause of gastroparesis. Controlling diabetes is the first step in the treatment of gastroparesis as it will help with symptomatic improvement. People with diabetes and ganstroparesis have wider fluctuations in blood glucose levels including unexpected hypoglycemia (e.g., low blood glucose level). Discuss with a diabetologist/endocrinologist about tight control of diabetes as well as lifestyle changes such as small and frequent low-fat meals.
What should you eat if you have gastroparesis?
Managing gastroparesis involves eating four to six small low-fat, low-fiber meals a day, rather than two or three big ones. For severe symptoms, food should be liquified or pureed before eating.
What causes gastroparesis to flare up?
People with gastroparesis either live with constant daily symptoms or cycle between calm periods and flare-ups. What causes gastroparesis flare-ups is imperfectly understood. Medications to control gastroparesis symptoms do not prevent flare-ups.
What drug promotes gastric emptying?
Prokinetic drugs such as metoclopramide increase the strength and frequency of stomach muscle contractions and so cause the stomach to empty its contents more quickly. Side effects can be intolerable, however, and many patients quit metoclopramide because of the side effects.
Are there any new treatments for gastroparesis?
New treatments are always being developed for gastroparesis. But promising new treatments don’t always work out. Tricyclic antidepressants, for instance, were once used to reduce nausea in gastroparesis patients, but they were not effective because they slowed down stomach emptying. Promising new drugs on the horizon include prokinetic drugs similar to metoclopramide, such as cisapride and prucalopride. Relamorelin, an experimental new drug unrelated to other prokinetic agents, is currently in clinical trials.
Does gastroparesis go away?
For most people, gastroparesis is a chronic, lifelong condition that does not go away. However, some cases may be temporary. Gastroparesis caused by surgery, medications, and, sometimes, diabetes can resolve or significantly improve when the underlying condition is resolved.
Does Zofran help gastroparesis?
Zofran (ondansetron) is a powerful medication for controlling nausea. It is normally used to reduce nausea in patients undergoing cancer chemotherapy or radiation therapy but is also highly effective in reducing nausea due to gastroparesis. Zofran does, however, have serious side effects and its long-term safety has not been established.
What is the best medication for gastroparesis?
The front-line drug therapies for gastroparesis are prokinetic drugs that increase the strength and frequency of stomach muscle contractions. Most patients will be started on metoclopramide, but side effects may require that they be moved to other prokinetic drugs such as domperidone, tegaserod, erythromycin, or azithromycin.
What medications make gastroparesis worse?
Gastroparesis is a side effect of narcotics, calcium channel blockers, tricyclic antidepressants, antipsychotics, progesterone, lithium, and a type of Type 2 diabetes drug called glucagon peptide agonists such as Trulicity (dulaglutide) or Byetta (exenatide). These medications slow down gastric emptying and will make gastroparesis symptoms worse.
Is gastroparesis serious?
Severe cases of gastroparesis can result in serious and even life-threatening complications such as malnutrition, dehydration, bacterial infections, and blockage caused by bezoars (lumps of hardened food in the stomach). The condition can significantly decrease the quality of life and can be severe enough to qualify as a disability.
Is salad good for gastroparesis?
Fiber-rich foods, such as salads, whole grains, raw vegetables, and many fruits slow down stomach emptying and will worsen gastroparesis symptoms.
Are bananas good for gastroparesis?
Gastroparesis symptoms result from food not emptying from the stomach as it normally does. Fiber-rich foods slow down stomach muscles and will worsen gastroparesis symptoms. Avoid foods like raw vegetables (carrots, broccoli, lettuce), raw fruits (bananas, pineapples, oranges), hot cereals, whole grains, and fiber laxatives.