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Patient Education

Gastroparesis

What is Gastroparesis?

Gastroparesis is a condition where the stomach is unable to empty food normally.  Literally translated, gastroparesis means “stomach paralysis.” It can cause heartburn, nausea, vomiting, and may be treated with medications or surgery.  Gastroparesis is a common condition among people who have had diabetes for a long time but can also occur in people without diabetes.

Gastroenterology Consultants of San Antonio - Gastroparesis

Gastroparesis

Gastroparesis Symptoms

It’s possible to have gastroparesis and not have any symptoms.  When symptoms of gastroparesis are present, they include:

  • Heartburn / Acid Reflux / Gastrointestinal Reflux (GERD)
  • Nausea
  • Vomiting
  • Feeling full quickly when eating
  • Abdominal pain or bloating
  • Loss of appetite / Weight loss / Malnutrition
  • Changes in blood sugar

 

Gastroparesis Causes

Doctors may not always be able to prove what’s causing gastroparesis.  In most cases, gastroparesis is caused by damage to the vagus nerve.

The vagus nerve controls the stomach muscles.  If it is damaged, the stomach muscles will not contract and move food out of the stomach and into the small intestine in a normal way. This is also known as delayed gastric emptying.

Potential causes of gastroparesis and vagus nerve damage:

  • Diseases, such as diabetes
  • Infections
  • Abdominal surgery that results in damage to the vagus nerve

Medications Associated with Impaired  Gastric Emptying

  • Narcotics
  • Tricyclic antidepressants
  • Calcium channel blockers
  • Clonidine
  • Dopamine agonists
  • Lithium
  • Nicotine
  • Progesterone

Gastroparesis Risk Factors

The risk for gastroparesis increases with:

  • Diabetes
  • Abdominal surgery
  • Infection
  • Certain medications, including some antidepressants and narcotics.
  • Scleroderma (connective tissue condition that can affect internal organs)
  • Nervous system disorders, like MS or Parkinson’s.
  • Gender: Women are more likely to develop gastroparesis than men.

Gastroparesis Complications

Complications of gastroparesis include:

  • Dehydration
  • Malnutrition
  • Bacterial growth – food that stays in the stomach too long can ferment and lead to bacterial growth.
  • Bezoars – bezoars are solid masses that form in the stomach from undigested food. They can cause nausea, vomiting, and could be life-threatening if they block the pathway between the stomach and small intestine.
  • Unpredictable blood sugar levels – when emptying of food from the stomach is unpredictable, blood sugar levels are also unpredictable.  This can impact people with diabetes.

Gastroparesis Diagnosis

In addition to reviewing your medical history, performing a physical exam, and blood tests, your doctor may recommend the following tests or procedures to aid in the diagnosis of gastroparesis:

Upper Endoscopy

Using a thin, lighted tube with a camera on the end, the doctor will inspect the esophagus, stomach, and the first part of the small intestine. This test may also rule out other conditions that have the same symptoms as gastroparesis.

Gastric Emptying Study

One of the most definitive tests in diagnosing gastroparesis is a gastric emptying study.  In this test, patients eat a small meal (such as an egg or oatmeal) with a small amount of radioactive material. Then, a scanning device is used to track the progress of food through the stomach. Talk to your doctor about any medications you’re taking before this study, as some could impact the results.

SmartPill

The SmartPill is a small, non-digestible wireless capsule that transmits information about digestion to a receiver the patient wears around their waist.  The information includes the pH level, temperature, and pressure changes throughout the digestive tract. This can help determine how quickly the stomach is emptying.

Imaging Tests

Your doctor may recommend an ultrasound or upper GI series x-ray to rule out other possible causes of your symptoms.

Gastroparesis Treatment & Diet

Treatment usually begins by identifying and treating the underlying cause of gastroparesis.  If the cause is diabetes, your doctor will make recommendations for treatment.

Gastroparesis Diet

Making sure you get adequate nutrition is important when managing gastroparesis. Diet changes usually help people manage gastroparesis and are the first step in treatment. It may be helpful to visit with a registered dietitian who can work with you to identify foods that are easier to digest.

Most people with gastroparesis can lead a relatively normal life by eating softer foods and drinking supplemental nutritional drinks.

Other gastroparesis diet advice includes:
  • Eat smaller meals (instead of 3 meals a day, have 5 or 6 smaller meals throughout the day)
  • Chew food completely
  • Choose cooked vegetables and fruits over raw, uncooked fruits and vegetables
  • Avoid fibrous vegetables and fruits, including broccoli and oranges
  • Avoid fatty-foods (these can slow digestion)
  • Drink plenty of water each day (1 to 1.5 liters)
  • Take a walk after you eat
  • Avoid alcohol, smoking, and carbonated beverages
  • Try not to lay down within 2 hours of eating

Below are recommended diet choices for people with gastroparesis.  This is not an exhaustive list, and a dietitian can provide a more complete list.

Starches

  • White bread and rolls
  • Light-colored whole wheat bread (without seeds or nuts)
  • Plain bagels
  • English muffins
  • Corn and flour tortillas
  • Pancakes
  • Cream of wheat
  • Saltines and other white crackers
  • White potatoes and sweet potatoes (without skin)
  • French fries (baked only, not fried)
  • Rice
  • Pasta
Proteins

  • Lean beef, pork, and veal
  • Chicken and turkey (not fried and without skin)
  • Lobster, crab, shrimp, oysters, clams, scallops
  • Tuna (in water, not oil)
  • Cottage cheese
  • Tofu
  • Eggs
Fruits and vegetables

  • Tomato sauce, puree, paste, juice
  • Cooked carrots, beets, and mushrooms
  • Vegetable broth and juice
  • Fruit drinks and juices
  • Applesauce
  • Bananas
  • Pears and Peaches (canned)
Dairy

  • Milk (if tolerated)
  • Yogurt
  • Pudding and custard
  • Frozen Yogurt

Gastroparesis Medications

  • Metoclopramide (Reglan) – This medication acts on the dopamine receptors in the stomach and can stimulate the stomach muscles.  Serious side effects can occur, and it should not be taken long term.
  • Erythromycin (Eryc, E.E.S.) – erythromycin is an antibiotic that stimulates the motilin receptors of the stomach.  This causes the stomach to contract and pass food. Over time, a medication tolerance can build up making the medication less effective with long-term use.  This medication may also cause diarrhea.
  • Domperidone – This medication also acts on the dopamine receptors, but has shown to have fewer side effects than Metoclopramide. Its use is restricted in the United States but domperidone is used in Mexico, Canada, and European countries.

Gastroparesis Surgery

Surgery for gastroparesis is reserved for people with severe symptoms that do not respond to other treatments.  Surgical options include the placement of venting tubes into the stomach. Thes venting tubes may reduce symptoms in patients with recurrent dehydration and vomiting.

A percutaneous jejunostomy tube may be installed if nutritional supplementation is necessary.

In some cases, the lower part of the stomach may be stapled or bypassed to improve stomach emptying.

Electrical Stimulation for Gastroparesis

One area of medical research is looking at electrical stimulation to treat gastroparesis.  Small electronics are attached to the stomach wall. Once activated, they can cause the stomach to contract.  Studies haven’t shown significant improvements in stomach emptying, but have shown to reduce bothersome symptoms of gastroparesis like nausea and vomiting.

Gastroparesis FAQ

What foods should you avoid if you have gastroparesis?

Foods to avoid with gastroparesis include raw fruits and vegetables, fibrous fruits and vegetables (oranges, broccoli), high-fat foods, carbonated drinks, and alcohol.

What is the best treatment for gastroparesis?

The best treatment for gastroparesis will depend on each individual patient and their response to treatment.  Medications and surgery should only be considered after dietary and lifestyle changes.

Can you reverse gastroparesis?

There is no cure for gastroparesis, but most people can find relief through dietary changes and medication.

Are bananas good for gastroparesis?

Yes, bananas are considered ‘safe’ food for people with gastroparesis.

Can gastroparesis kill you?

Gastroparesis is generally non-life-threatening, but the complications can be serious.  They include malnutrition, dehydration, or a bezoar completely blocking the flow of food out of the stomach.


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