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Gastroparesis

Also called delayed gastric emptying

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This article is for general information only and does not constitute medical advice. Please consult your doctor or a qualified health professional regarding your individual circumstances.

Gastroparesis is a condition where the stomach takes much longer than normal to empty its contents into the small intestine. Normally, stomach muscles (controlled by the vagus nerve) contract to break up food and move it through the digestive system. With gastroparesis, these muscles work poorly or not at all; food moves too slowly or stops moving altogether. [1,4]

Gastroparesis
Also called delayed gastric emptying
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Causes

In most people, the cause is unknown (idiopathic gastroparesis). The most common identifiable cause is diabetes; long-term high blood sugar levels can damage the vagus nerve. Other causes include:[1]

  • Intestinal surgery that affects the nerves supplying the stomach
  • Neurological conditions such as Parkinson's disease or multiple sclerosis

Gastroparesis is more common in women than in men, though the reason is unclear.

Symptoms

The most common symptoms are:[1,2]

  • Nausea
  • Feeling full after eating only a small amount of food
  • Vomiting undigested food, sometimes several hours after a meal

Other symptoms may include acid reflux, stomach area pain, abdominal bloating, and loss of appetite. Symptoms can be mild or severe and may vary over time.

Diagnosis

Diagnosis involves a physical exam, medical history, blood tests, and specific tests. Your doctor may first rule out blockages:[1]

  • Upper GI endoscopy: a camera checks for blockages or bezoars (hard masses of undigested food)
  • Upper GI series (Barium X-ray): barium coats the digestive tract to make abnormalities visible on X-ray
  • Ultrasound: checks for gallbladder disease or pancreatitis
  • Gastric emptying scintigraphy: the most definitive test. You eat a meal containing a small, safe radioactive marker. An external camera tracks how quickly the stomach empties over 4 hours. Gastroparesis is confirmed if more than 10% remains at 4 hours.[1]

Treatment

Treatment helps manage symptoms. Gastroparesis is usually a long-term condition. There is no single cure.

Diet and Eating Habits

Dietary modification is the cornerstone of gastroparesis management: [1,2]

  • Eat 6 small meals a day instead of 3 large ones.
  • Chew food thoroughly.
  • Drink non-carbonated fluids with meals.
  • Sit upright or take a short walk after eating; avoid lying down for at least 2 hours.
  • Avoid high-fat foods; fat slows digestion.
  • Reduce high-fibre raw vegetables and fruits, as these take longer to digest.
  • During flare-ups, soft or pureed foods and liquid-based meals may help, as liquids leave the stomach faster.

A dietitian can help plan meals that relieve symptoms while meeting your nutritional needs.

Medications

  • Metoclopramide: stimulates stomach contractions and reduces nausea. Take 20-30 minutes before meals and at bedtime. Rare risk of a movement disorder (tardive dyskinesia) with long-term use.[1]
  • Erythromycin (low dose): stimulates stomach contractions. Side effects include nausea, vomiting, and stomach cramps.
  • Anti-nausea medications (antiemetics): to manage nausea and vomiting.

Other Procedures

  • Botulinum toxin (Botox): injected into the pylorus (stomach outlet) during endoscopy to keep it open for longer. Results have been mixed.[4]
  • Gastric electrical stimulation: a small device is surgically implanted to send electrical pulses to the stomach muscles to help control nausea and vomiting.[1]
  • Jejunostomy feeding tube: for severe cases, a tube placed directly into the small intestine bypasses the stomach for feeding.
  • Parenteral nutrition (IV feeding): nutrition delivered directly into the bloodstream through a chest vein. Usually a temporary measure for very severe cases.

Gastroparesis and diabetes

For people with diabetes-related gastroparesis, blood sugar control is essential but difficult. Food is absorbed unpredictably, making glucose levels erratic. Your doctor may need to adjust your insulin type, timing, or doses. Recommendations often include taking insulin after meals rather than before and checking blood sugar more frequently. Liquid or pureed meals may help stabilise both symptoms and blood sugar.[5]

Complications

Potential complications of gastroparesis include: [1,4]

  • Severe dehydration from ongoing vomiting
  • GORD and oesophagitis
  • Bezoars (hardened masses of undigested food)
  • Poor blood sugar control in people with diabetes
  • Malnutrition
  • Reduced quality of life and work absences

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