Gastroparesis

Gastroparesis, also called delayed gastric emptying, is a condition where your stomach can’t empty properly, so food doesn’t move into the small intestine as quickly as it should. With it, you may notice nausea, vomiting, weight loss and bloating. 

When you understand gastroparesis and its causes, symptoms and treatment, you can manage it better and improve your quality of life.

What is gastroparesis?

Gastroparesis is a chronic (long-lasting) issue where your stomach muscles don’t work properly, so food can’t move through your digestive system at the right speed. In the normal digestive process, your stomach breaks your food down into smaller pieces and pushes food into the first part of the small intestine. In gastroparesis, this process is slow or stops altogether.

Gastroparesis can affect anyone but it is more common in women. You could develop it as a complication of diabetes, surgery or neurological conditions like multiple sclerosis. In some cases, there’s no known cause. That’s called idiopathic gastroparesis.

According to the National Institute of Diabetes and Digestive and Kidney Diseases, untreated gastroparesis can lead to poor nutrition, blood sugar fluctuations and dehydration. 

Symptoms of gastroparesis

With gastroparesis, symptoms can range from mild discomfort to severe digestive issues. Symptoms may come and go or may last for a long time. They can affect your day-to-day activities and overall well-being. 

Common symptoms include: 

• Nausea and vomiting, especially after eating
• Feeling full quickly, even after small meals (early satiety)
• Feeling full for a long time after you stop eating
• Abdominal (belly) bloating or pain 
• Weight loss
• Poor appetite
• Frequent belching
• High blood sugar fluctuations, especially if you have diabetes 
• Acid reflux or heartburn
• Trouble controlling blood sugar levels

If you have symptoms of gastroparesis, talk to your health care provider. A lot of different conditions can cause these symptoms so it’s important to see your provider for the right diagnosis.

It’s important to contact a health care provider right away for: 

• Severe nausea and vomiting that makes it impossible for you to eat or drink
• Vomiting blood or vomit that looks like coffee grounds
• Unexplained weight loss or malnutrition
• Long-lasting or intense abdominal pain or bloating
• Trouble managing high blood sugar even with medications

Causes and risk factors

Gastroparesis can develop for several reasons: 

• Diabetes: High blood sugar can damage your vagus nerve, which controls stomach emptying. Diabetes is the most common cause of gastroparesis.
• Neurological disorders: Conditions like multiple sclerosis or Parkinson’s disease can affect nerve signals to your stomach. 
• Some autoimmune diseases: Scleroderma, for example, may cause gastroparesis.
• Surgery or injury: Surgeries that involve the esophagus, stomach or abdomen may damage nerves or muscles. 
• Cancer treatment: Radiation therapy on your stomach or chest can increase your risk.
• Viral infections: Some infections can damage stomach muscles or nerves. This type of gastroparesis usually clears up when the infection goes away.
• Idiopathic gastroparesis: In many cases, there’s not a clear cause for the condition.
• Medications: Some medications and recreational drugs can interfere with the nerve signals that stimulate your stomach muscles.
• Hypothyroidism: Poor thyroid function can delay muscle function.

Diagnosing gastroparesis

A thorough diagnosis is the first step in managing gastroparesis. Your health care provider will ask you about your medical history, symptoms, medications and previous surgeries. They will want to know if you have diabetes, scleroderma or nervous system disorders. They will check for signs of dehydration, malnutrition or abdominal tenderness.

They may order tests such as:

• Blood tests: Signs of dehydration, malnutrition, infection and inflammation can show up in your blood.
• Urine tests: These tests can uncover signs of diabetes, kidney problems, dehydration and infection.
• Upper endoscopy: Your provider inserts a flexible tube with a camera through your mouth to look for blockages or abnormalities in the esophagus, stomach and small intestine. 
• Gastric emptying test: This test measures how quickly food leaves the stomach. For it, you eat a meal that contains a small amount of radioactive material, and imaging scans track how it moves through your digestive system. This test should only be done after an upper endoscopy has shown no physical obstruction in the stomach.
• Imaging tests: Ultrasounds or CT scans can check for structural problems in the digestive tract. 
• SmartPill test: You swallow a small electronic capsule that measures how quickly food moves through the stomach and intestines. The capsule passes out of your body in your stool within a few days.
• Electrogastrography: This test checks for issues in the electrical activity of your stomach muscles. 

Treating gastroparesis

To treat gastroparesis, your provider will focus on managing your symptoms, helping your stomach empty properly and getting the nutrients you need. 

Medications 

Your health care provider may prescribe:

• Prokinetics: Medications like metoclopramide and domperidone make your stomach muscles contract, so food moves through the digestive system faster. 
• Antiemetics: Drugs like ondansetron or promethazine help reduce nausea and vomiting. 
• Pain medications: These may be prescribed to help with abdominal discomfort.

Blood sugar control

If you have diabetes and gastroparesis, you will need to keep your blood glucose levels controlled. Your provider will give you instructions on what to do. You may need to check your blood glucose levels more often and change the way you take insulin.

Dietary and lifestyle changes

It may help to:

• Eat small, frequent meals instead of large ones
• Avoid high-fat and high-fiber foods, which are harder to digest
• Steer clear of carbonated drinks and alcohol
• Drink plenty of water
• Chew your food thoroughly or choose pureed or liquid foods since they are easier on your stomach
• Stay hydrated to prevent dehydration
• Get physical activity to help keep food moving through your digestive system
• Don’t lay down for at least two hours after eating

Here’s a sample meal plan for gastroparesis: 

• Breakfast: Smoothie with yogurt, banana and protein powder
• Lunch: Mashed potatoes with well-cooked vegetables and grilled chicken
• Dinner: Blended vegetable soup with lean ground turkey

Feeding tubes and IV nutrition

If you have a severe case of gastroparesis, you may need a feeding tube. A feeding tube can go from your nose or mouth down your esophagus and past your stomach to send nutrients directly to the small intestine. If a feeding tube isn’t an option for you, your provider may recommend intravenous (IV) nutrition. 

Surgery and procedures

These treatments may also be options:

• Gastric electrical stimulation: A device is implanted to help regulate stomach contractions. 
• Botulinum toxin injections: Injections can relax the pyloric valve, which controls the flow of food from the stomach to the small intestine.
• G-POEM (Gastric-Per Oral Endoscopic Myotomy): This is an endoscopic procedure to carefully cut the muscle that controls the opening between the stomach and the small intestine (the pyloric sphincter). This allows food to move more easily from the stomach into the intestine, helping the stomach empty more easily.

Living with gastroparesis

To manage gastroparesis, you’ll need ongoing care and lifestyle adjustments. These tips can help:

• Track your symptoms to help figure out which foods trigger flare-ups. 
• Get gentle exercise, such as walking, to help keep your digestive system moving. 
• Follow up regularly with a gastroenterologist or other qualified health care provider to keep an eye on your progress.
• Consider joining an in-person or online support group so you can connect with others who understand your struggles.
• Get mental health support for anxiety or depression. Mental health conditions can make your symptoms worse. 

Why choose Banner Health for gastroparesis care?

Gastroparesis can be challenging, but with the right diagnosis and treatment, you can manage your symptoms and lead a healthier life. 

At Banner Health, we specialize in diagnosing and treating complex gastrointestinal tract disorders, including gastroparesis. We offer state-of-the-art diagnostic tools such as gastric emptying tests and advanced treatment options including minimally invasive procedures such as G-POEM.

Our team of gastroenterologists, dietitians and counselors is focused on providing compassionate care and effective solutions for people with gastroparesis.