What Is Gastroparesis?

Gastroparesis is a condition that occurs when your stomach doesn’t empty after eating as quickly as it should. Normally, this condition can happen if you have a physical blockage in your digestive system. If you have gastroparesis, it's common to experience symptoms such as nausea, stomach pain, and bloating.

Scientists estimate that up to 2% of the U.S. population may have gastroparesis, which tends to be more common in women than men. Currently, the exact cause of gastroparesis is unknown, but some researchers believe that it can be a complication of diabetes. While researchers are still learning how to fully treat the condition, the good news is that there are some therapies that can help you reduce symptoms.

Symptoms

Not everyone with gastroparesis has the same symptoms. However, some of the key symptoms of gastroparesis can include:

• Nausea or vomiting
• Feeling full after just starting a meal
• Excess belching
• Bloating
• Stomach discomfort or pain
• Decreased appetite which can lead to weight loss or malnutrition over time

Your symptoms can vary depending on how severe your condition is. People with mild gastroparesis may feel stomach discomfort from time to time, while those with moderate to severe gastroparesis can have nausea and difficulty completing meals.

Causes

Normally, your stomach empties the food you eat into the small intestine a few hours or so after eating. This requires a lot of complex coordination between your nerves, stomach muscles, and intestinal muscles in the digestive system. Researchers aren’t sure exactly what goes wrong in all cases of gastroparesis, but they suspect that a problem with the emptying process occurs when you have the condition.

Diabetes

The most common known cause of gastroparesis is diabetes. People with type 1 diabetes seem to have a greater risk of the condition compared to people with type 2 diabetes.

Gastroparesis from diabetes may at least partly result from damage to the nerves that send and receive signals from the stomach. These nerves are called autonomic nerves and may get damaged from the high blood sugar levels that a person experiences when they have diabetes. As a result, nerve damage can change how the stomach nerves and muscles process digestion.

Other Causes

While diabetes is the most likely reason you can experience gastroparesis, some other potential causes of the condition include:

• Nervous system disorders, like multiple sclerosis or Parkinson’s disease
• Muscular dystrophies
• Infectious diseases like the Epstein-Barr virus
• Cancer
• Certain autoimmune conditions, like lupus
• Eating disorders such as bulimia
• Severe kidney disease
• Hypothyroidism
• Complications following surgery

Many different medications can also temporarily cause or worsen gastroparesis in some people. Some of these drugs include:

• Opioids like Oxycontin (oxycodone)
• Medications for acid reflux, like Prilosec (omeprazole)
• Medications for high blood pressure, like Norvasc (amlodipine)
• Medications classified as “anticholinergic”, such as Clozaril (clozapine) and Benadryl (diphenhydramine)
• Marijuana and alcohol

However, it's important to note that much of the time gastroparesis is idiopathic, which means that your healthcare provider doesn't always know the underlying cause of the condition. 

Diagnosis

If you suspect you have gastroparesis or may be experiencing symptoms of the condition, it's good practice to see your healthcare provider for proper testing. During your appointment, your provider will take a detailed medical history and conduct a physical exam to learn more about your symptoms.

Keep in mind: the symptoms of many different medical conditions can look similar to the symptoms of gastroparesis, so it’s important for your provider to rule out other potential causes. Depending on the situation, your provider may also test you for the following conditions before making a diagnosis:

• Chronic pancreatitis
• Gastroesophageal reflux disease (GERD)
• Ulcers
• Cyclic vomiting syndrome
• Eating disorders
• Obstruction in the stomach or small intestine (e.g., from a tumor)
• Functional dyspepsia

To test you for gastroparesis and the above conditions, your provider can order one or more of the following tests:

• Blood tests: Can check for your complete blood cell count (CBC), hemoglobin A1C, and glucose (blood sugar).
• Esophagogastroduodenoscopy (EGD): A surgical procedure that allows your provider or surgeon to check your esophagus and stomach for physical obstructions or blockages (e.g., a tumor)
• Gastric emptying scintigraphy (GES): Tests how long it takes for your food to empty from your stomach
  
• Gastric emptying breath test: A lower cost alternative to the GES test, but oftentimes less accurate in diagnosing gastroparesis
• Wireless motility capsule test: Checks for dysfunction in your stomach muscles

Unfortunately, many people with gastroparesis don't always receive an official diagnosis because symptoms often mimic the symptoms of other health conditions. Researchers are hopeful that as they learn more information about the condition, healthcare providers will have the tools to accurately diagnose and treat gastroparesis.

Treatment

At this time, there is no cure for gastroparesis. However, treatment can help reduce your symptoms. Your exact treatment plan will depend on the symptoms you have and the severity of your condition. Treatment options may include changes to your nutrition, medications, and certain procedures.

Nutrition

Dietary changes are the gold standard for managing gastroparesis. Your healthcare provider may work with a nutritionist or dietician to provide the following advice:

• Eat smaller but more frequent meals (e.g., three small meals with two snacks)
• Avoid high-fat foods
• Limit high-fiber foods

It’s also good to eat foods that are easy to mash up with a fork (e.g., soft potatoes) while avoiding foods with more solid components (with peels, husks, seeds, etc.) Soups are often a good option because they make it easier for the stomach to empty without any dysfunction.

Medications

Sometimes, dietary management is not enough. That said, you might need to use medication to reduce nausea and vomiting and help your stomach empty. Your provider can work with you to prescribe the medication that is best for you. Examples of medications they may consider include:

• Reglan (metoclopramide)
• Motilium (domperidone)
• E-Mycin (erythromycin)
• Neoprad (levosulpiride)
• Zofran (ondansetron)
• Pamelor (nortriptyline)
• Emend (aprepitant)

Procedures

Some people with severe gastroparesis may also benefit from certain medical procedures. Your treatment plan may include:

• Repeated botulinum (botox) injection in the pylorus—the opening at the end of the stomach
• Pyloroplasty, or surgery to widen the pylorus opening
• Pyloromyotomy, or surgery to cut through the wall of the pylorus
• Surgery that implants an electrical stimulation device in your stomach to help it empty

How to Prevent Gastroparesis

Studies have shown that people with diabetes whose blood glucose (blood sugar) isn’t well controlled have a higher risk of eventually developing gastroparesis. If you live with diabetes, it's best to keep your blood sugar levels in a healthier range to help prevent gastroparesis, along with other complications, from occurring.

Because the cause of gastroparesis is not yet well understood, healthcare providers don't have many other prevention strategies that stop or delay the onset of gastroparesis. That said, your provider may recommend eating a nutritious diet that is right for you, getting exercise, and drinking plenty of water to keep your digestive system functioning as efficiently as possible.

Related Conditions

Certain medical conditions are more common in people with gastroparesis. These conditions include:

• Anxiety
• Depression
• Chronic pancreatitis
• Kidney disease
• Hypothyroidism
• Lupus

If you receive a diagnosis for gastroparesis, it's a good idea to talk to your healthcare provider about what you can do to lower the risk of experiencing symptoms of the above conditions.

Living With Gastroparesis

Unfortunately, the chronic nausea and pain of gastroparesis can significantly affect your quality of life. Existing treatments, although helpful, don't always get rid of symptoms. Researchers are still actively pursuing new drugs and procedures that might be helpful in the future to help treat the condition.

Food is often a personal preference and lifestyle decision, and it can be frustrating not to eat as you would like when your provider recommends a particular diet. However, it’s important to be realistic about avoiding the kind of foods that can worsen your symptoms. If you need help figuring out a diet that works for you, ask your provider about meeting with a licensed nutritionist or dietician for help.

If you believe your symptoms are affecting your emotional well-being, it's also a good idea to get in touch with a support group or meet with a mental health professional for added support.