What to Know About Gastroparesis (Delayed Stomach Emptying)
This article defines gastroparesis and explains the symptoms and risk factors. It also explores available treatment options, including dietary changes, and the outlook for people with gastroparesis.
“Gastro” refers to the stomach, and “paresis” means muscular weakness or paralysis. Usually, muscles in the stomach wall contract to crush food and mix it with digestive juices. The muscles then move this slurry into the small intestine, where nutrient absorption occurs.
According to the National Institute of Diabetes and Digestive and Kidney Disorders (NIDDK), gastroparesis prevents the muscles from working how they should. This causes gastric motility to slow down or stop. Other names for the condition include “delayed gastric emptying” and “slow stomach.”
Gastroparesis causes a variety of digestive symptoms. It also can lead to serious problems, including malnutrition and dehydration.
In gastroparesis, digestion does not take place as it normally should. Symptoms are the result of the delay in digestion and stomach emptying.
Common symptoms of gastroparesis
Some common symptoms of gastroparesis include:
- abdominal pain
- bloating, belching, heartburn, and acid reflux
- blood sugar changes and difficulty maintaining blood sugar control
- decreased appetite
- a prolonged feeling of fullness and an immediate feeling of fullness after a few bites
- nausea and vomiting, which can involve vomiting undigested food several hours after a meal
- unintentional weight loss
Symptoms that might indicate a serious condition
In some cases, gastroparesis can cause serious problems, such as dehydration. Sudden digestive symptoms can also indicate a more serious condition.
Seek immediate medical care (call 911) for any of these serious symptoms:
- difficulty breathing, lightheadedness, or fainting
- severe abdominal pain or cramping
- symptoms of dehydration, including dark urine and extreme thirst
- vomiting blood or a material resembling coffee grounds
- uncontrollable or prolonged vomiting
If you have milder symptoms that cause concern, contact your doctor for an evaluation. Several other conditions cause many of the same symptoms. Getting the correct diagnosis is the first step toward receiving effective treatment.
Gastroparesis most likely results from damage to the nerves controlling the stomach muscles. The vagus nerve, in particular, is involved in signaling the stomach muscles to work. Sustaining damage to the vagus nerve can cause abnormal signaling and digestion delays.
During diagnosis, a doctor may identify an underlying cause of the nerve damage. Some conditions linked to a higher chance of developing gastroparesis include:
- Diabetes: Chronically high blood sugar levels can damage nerves.
- Surgical complications: Trauma to the vagus nerve is a potential complication of surgery on the esophagus, stomach, or small intestine.
- Radiation exposure: Nerve damage from radiation to the chest or abdomen carries a risk of gastroparesis.
- Medication side effects: Narcotics, lithium, certain antidepressants, and other drugs are linked to gastroparesis, according to the American College of Gastroenterology.
Also, females are more likely than males to develop gastroparesis.
You may be able to lower your risk of gastroparesis by:
- controlling your blood sugar levels if you have diabetes
- effectively treating other conditions linked to gastroparesis
- avoiding smoking and other forms of nicotine
- discussing side effects of the medications you take with your doctor or pharmacist
If you have gastroparesis, eating can become uncomfortable. However, there are some diet and nutrition tips that may help.
The following are some tips to improve digestion:
- Eat several small meals per day.
- Choose foods that are low in fat and fiber.
- Chew food as thoroughly as possible so that it is ready for digestion.
- Stay upright while eating and for 1–2 hours after.
- Walk or move around after eating.
- Drink plenty of water to stay hydrated.
- Keep a food journal to help you identify foods that cause discomfort.
If you have difficulty eating solid foods, try drinking enriched or fortified drinks and soups. Alternatively, consume pureed foods.
Foods to avoid
It may be best to avoid foods and beverages in these categories:
- high fat foods, including:
- fatty meat
- full fat dairy products, such as butter and ice cream
- high fiber foods, including:
- apples with the peel
- whole grain foods, such as bran, oatmeal, and popcorn
- baked beans
- high starch foods, such as pasta
- greasy or fried foods
- foods that are hard to chew thoroughly, such as anything with a skin or peel
- carbonated beverages
Foods to include
Specific foods and beverages that may help with gastroparesis include:
- plant-based milk
- reduced fat peanut butter
- peeled or canned fruits
- fruit juice without pulp
- well cooked vegetables without peels
Ask your doctor for guidance before making any significant changes to your diet. Consider working with a dietitian or nutritionist to work out a daily meal plan if you have gastroparesis.
Staying hydrated and maintaining a moderate weight can also help.
Gastroparesis symptoms can be similar to those of other bowel-related conditions, such as irritable bowel syndrome. For this reason, your doctor will ask about your health, history, and symptoms. You may also need tests to confirm the gastroparesis diagnosis.
Some tests that can help diagnose gastroparesis include:
- blood tests
- endoscopy of the esophagus and stomach
- a gastric emptying study, which is a procedure wherein you consume food containing a trace amount of a radioactive substance
- a wireless motility capsule, which is a device that measures how well and how quickly your stomach empties
- a breath test, which is a procedure that measures how much carbon dioxide your body produces after eating
To diagnose your condition, your doctor will ask you questions like:
- What are your symptoms, and when did they begin?
- Do you have any other conditions? If so, what is your treatment plan?
- Are you taking any medications?
- What is your surgical history?
- Does anything make the symptoms better or worse?
Managing gastroparesis and its symptoms can require a number of treatments, according to the NIDDK. These range from making dietary changes to taking medications and undergoing surgery.
Physicians tailor treatments to the severity of the condition. They typically start with dietary and lifestyle remedies, especially for people with mild cases of delayed gastric emptying.
Dietary changes and self-care
The first step in treating gastroparesis is making dietary changes, according to the National Organization for Rare Disorders (NORD). For example, a dietitian can help you develop an eating plan that contains more easily digestible foods.
It may also be necessary to change the way you eat. For instance, eating smaller meals more frequently can be more comfortable than trying to eat larger portions less often. Also, doing some gentle exercise after eating can help keep digestion moving.
If you have diabetes, take care to control your blood sugar levels.
When making changes to your eating habits does not help, your doctor may prescribe medications. Keep in mind that these drugs cannot treat the underlying causes of gastroparesis, such as nerve damage.
Gastroparesis drugs can help reduce the symptoms, but some of them have side effects. Be sure to discuss the benefits and side effects of any medication your doctor recommends.
- promotility drugs, which stimulate the stomach muscles and include:
- metoclopramide (Reglan)
- erythromycin (Eryc)
- cisapride (Propulsid)
- domperidone (Motilium)
- antiemetics, which help control nausea and vomiting and include:
- prochlorperazine (Compazine)
- trimethobenzamide (Tigan)
- ondansetron (Zofran)
- pain medications, but not opioids, as these can worsen the condition
Surgery and other procedures
Doctors recommend surgery and more advanced treatments in some cases.
Possible procedures include:
- venting gastrostomy, which places a tube in the stomach to vent trapped air
- tube feeding, which refers to the delivery of liquid nutrition through a tube inserted into the small intestine
- gastric electrical stimulation, which is a treatment that involves sending electrical pulses to stimulate stomach muscle contractions
- Botox injections into the muscle that controls gastric emptying, which — according to the NORD — is an investigational therapy shown to provide temporary relief in some studies
If you have gastroparesis and regular treatment is not relieving your symptoms, ask your doctor about available clinical trials for gastroparesis.
Some complications of gastroparesis include:
- erratic blood sugar levels due to delayed stomach emptying and digestion
- a decreased quality of life
- bezoars, which are hardened collections of food and other materials in the stomach
Seeking care from a gastroenterologist who has significant experience treating gastroparesis may help reduce your risk of complications.
Many people with gastroparesis can manage their symptoms and function well with active treatment. Still, the condition currently has no cure, and some people cannot tolerate the medication options due to side effects.
Gastroparesis can decrease your quality of life and lead to disability. Malnutrition and dehydration can lead to vitamin deficiencies and electrolyte imbalances. These issues can lead to other medical conditions, such as osteoporosis and anemia.
If you have gastroparesis, openly communicating with your doctor and a dietitian can help you manage the symptoms of the condition and address any problems as they arise.
For emotional difficulties, contact a mental health professional for help. There are also gastroparesis support groups, such as the International Foundation for Gastrointestinal Disorders and the Gastroparesis Patient Association for Cures and Treatments.
Having gastroparesis means that your stomach empties digestive contents slower than usual. The condition can cause uncomfortable symptoms, such as nausea, vomiting, and a prolonged feeling of fullness.
Sometimes, gastroparesis can cause serious complications, such as blocked intestines or gastric ulcers. If you experience severe vomiting, abdominal pain, or dehydration or cannot keep down foods or liquids, contact your doctor right away.
The first line of treatment is making changes to the kinds of foods you eat and to how much you are eating at a time. There are also medications available to help stimulate gastric motility and stomach emptying and for symptom relief. People with severe gastroparesis may need a feeding tube in the small intestine to bypass the stomach.