Gastroparesis

What is gastroparesis?

Gastroparesis is a condition in which food stays in the stomach for longer than normal. Usually, the muscles around the stomach contract and grind food into small pieces, then mix those small pieces with acids and enzymes so the food can start to be digested. The muscles then contract (tighten) and push food out of the stomach into the first part of your small intestine (duodenum).

If you have gastroparesis, the muscles around your stomach don’t work properly. This means that food isn’t broken down as much as normal, and it stays in the stomach for longer.

What causes gastroparesis?

The causes of gastroparesis are not clear. It seems that in some people, the nerve to the muscles around the stomach (called the vagus nerve) doesn’t work properly. For some people, the muscles themselves don’t work as well as they should.

You are more at risk of developing gastroparesis if you have diabetes. Gastroparesis is one of the complications of nerve damage caused by poorly controlled blood glucose levels.

Other causes include:

• stomach surgery
• diseases such as Parkinson’s disease, multiple sclerosis, scleroderma, and amyloidosis
• certain medicines such as opioids (prescribed pain-relief medicines) and some antidepressants

In some cases, there is no obvious reason for gastroparesis.

What are the symptoms of gastroparesis?

If you have gastroparesis, you may not digest your food properly, which can make you feel bloated and nauseous after a meal. Some people also:

• vomit, usually after meals
• feel very full or bloated after eating
• have reflux, heartburn or severe abdominal pain
• get diarrhoea, usually at night
• lose their appetite and lose weight

When should I see my doctor?

If you are having any of these symptoms and think you might have gastroparesis, it is important to see your doctor.

How is gastroparesis diagnosed?

To diagnose gastroparesis, your doctor will talk to you, examine you and refer you for some blood tests. You may also be referred for other investigations, such as a gastric emptying study, an ultrasound, or endoscopy. You may need to see a gastroenterologist (specialist in digestive disorders).

How is gastroparesis managed?

Although gastroparesis cannot be cured, there are things you can do to relieve your symptoms, including:

• eating small frequent meals
• eating easy-to-digest foods (such as soft foods or liquids)
• chewing food well
• avoiding high fat and high fibre food

There are medicines that your doctor might prescribe to help control the symptoms of gastroparesis. Domperidone, which improves muscle contraction in the stomach, and can help food move along the gastrointestinal tract. Metoclopramide can help manage nausea and vomiting.

If your symptoms don’t improve with dietary changes and medicines, you may need to have a medical procedure or surgery. Some doctors recommend inserting a pacemaker into the stomach to help the muscles in the stomach to contract. This is called gastric electrical stimulation.

If you have diabetes, controlling your blood sugar is an important part of your treatment. High blood sugar levels are associated with delayed emptying of the stomach, so by controlling your blood sugar levels, you can also help manage gastroparesis. Speak with your doctor or diabetes educator for tips and suggestions on how to best manage your diabetes.

In very severe cases, your doctor may recommend inserting a feeding tube, or surgery.