Gastroparesis

Diagnosis

Medical professionals employ various tests to aid in the diagnosis of gastroparesis while also excluding other conditions that may exhibit similar symptoms. These tests can include:

• Gastric emptying tests: To see how fast your stomach empties its contents, one or more of these tests may be recommended:
  • Scintigraphy. The primary diagnostic test for gastroparesis involves consuming a light meal, often consisting of items like eggs and toast, which incorporates a trace amount of radioactive material. A specialized scanner is then positioned over your abdominal area to track the movement of this radioactive material, assessing the pace at which food exits the stomach. It’s crucial to discontinue any medications that could potentially impede gastric emptying before undergoing this test, and it’s advisable to consult your doctor to determine if any of your prescribed medications might have such an effect on your digestion.
  • Breath tests. For breath tests, you consume a solid or liquid food that contains a substance that your body absorbs. Eventually, the substance can be detected in your breath. Samples of your breath are collected over a few hours and the amount of the substance in your breath is measured. The test can show how fast your stomach empties after consuming food by measuring the amount of the substance in your breath.
• Imaging:
  • Upper gastrointestinal (GI) endoscopy: This procedure is used to visually examine your upper digestive system — your esophagus, stomach and beginning of the small intestine (duodenum). It uses a tiny camera on the end of a long, flexible tube. This test can also be used to diagnose other conditions, such as peptic ulcer disease or pyloric stenosis, which can have symptoms similar to those of gastroparesis.
  • Ultrasound: This test uses high-frequency sound waves to produce images of structures within your body. Ultrasound can help diagnose whether problems with your gallbladder or your kidneys could be causing your symptoms.

Treatment

Healthcare providers are unable to directly repair the underlying damage responsible for gastroparesis. However, they can provide treatments aimed at promoting stomach muscle contractions and facilitating stomach emptying. Medications are typically the initial treatment approach, while surgery is considered for individuals who do not respond to medications or are unable to tolerate them. It’s important to note that each treatment option may have potential side effects, and effectiveness can vary from person to person.

The primary objectives of treatment are as follows:

• Enhance stomach muscle function and promote stomach emptying.
• Ensure that the body receives adequate nutrition and hydration.
• Alleviate symptoms and manage any treatment-related side effects.
• Address the underlying cause, when possible, to prevent further deterioration of the condition.

Nutrition

The most important thing when dealing with gastroparesis is to make sure you get the right nutrition. Many people with this condition can manage it by changing their diet. Your doctor might send you to a dietitian who can help you find foods that are easier for your stomach to handle. This way, you can still get the calories and nutrients you need from your meals.

There are some simple dietary tips a dietitian might suggest:

• Eat smaller meals more often throughout the day.
• Chew your food thoroughly before swallowing.
• Choose cooked fruits and veggies over raw ones.
• Avoid tough fruits and veggies like oranges and broccoli, as they can be hard to digest.
• Pick mostly low-fat foods, but you can have a bit of fatty food if you can handle it.
• Consider soups and pureed foods, especially if liquids are easier for you to eat.
• Make sure you drink about 34 to 51 ounces (1 to 1.5 liters) of water every day.
• Do some light exercise, like taking a short walk, after you eat.
• Stay away from fizzy drinks, alcohol, and smoking.
• Try not to lie down for at least two hours after a meal.
• Take a daily multivitamin to make sure you’re getting all the essential nutrients.

Medication

The primary treatment approach for gastroparesis involves the use of prokinetics, which are medications designed to enhance gastrointestinal motility. These prokinetic medications encompass various options:

• Metoclopramide: This is the sole FDA-approved drug for gastroparesis treatment. It operates by stimulating contractions in the stomach muscles and can also alleviate nausea. However, it carries a black-box warning due to potential neurological side effects such as tremors and muscle twitching.
• Motolin Agonists: Motolin agonists present an alternative class of prokinetic drugs that healthcare providers may recommend. Examples include erythromycin and azithromycin, which are typically used as antibiotics but are sometimes prescribed off-label to address gastroparesis.
• Serotonin Agonists: Two serotonin agonists, namely Tegaserod and prucalopride, are typically prescribed to promote bowel movements in individuals experiencing constipation. While their efficacy for gastroparesis treatment hasn’t been extensively studied, some healthcare providers may still consider them for this purpose.
• Dopamine Antagonists: Domperidone is a medication that enhances gastric motility and reduces nausea by blocking the action of dopamine, a neurotransmitter.

Additional medications that may be considered include:

• Antiemetics: These are prescribed to manage nausea and vomiting.
• Proton Pump Inhibitors: These drugs are used to address acid reflux.
• Analgesics: Pain relievers may be recommended for individuals experiencing significant stomach pain.
• Diabetes Medications: Some individuals with gastroparesis may require diabetes medications to regulate their blood sugar levels.

Surgery

When all other treatments fail in addressing gastroparesis, surgery becomes the last option. There are two main surgical procedures for gastroparesis:

• Pyloroplasty: This surgery modifies the pylorus, the valve at the bottom of the stomach responsible for food emptying. In a traditional pyloroplasty, the surgeon cuts into the pylorus muscle to widen the opening. A more recent variation, known as G-POEM (gastric peroral endoscopic myotomy), is performed endoscopically. Instead of abdominal incisions, the surgeon uses a long tube inserted through the mouth to access and modify the pylorus from within the stomach.
• Gastric Bypass: In some cases, individuals may require a gastric bypass procedure. This involves either removing or closing off a portion of the stomach and creating a new connection between the remaining stomach and the small intestine (gastrojejunostomy). Gastric bypass surgery is commonly used for weight loss, particularly for those with obesity-related Type 2 diabetes. It can also be recommended for severe diabetes-related gastroparesis.