Gastroparesis

Condition Basics

What is gastroparesis?

After a meal, the stomach normally empties in 1½ to 2 hours. When you have gastroparesis, your stomach takes a lot longer to empty. The delay results in bothersome symptoms that may become more severe over time.

Bezoar is a fairly rare condition related to gastroparesis. In this condition, food stays in the stomach for a long time and forms a hard lump. This causes food to get stuck in the stomach.

What causes it?

Gastroparesis occurs when the nerves or muscles to the stomach are damaged or don't work. Diabetes is one of the most common causes. Other causes include some disorders of the nervous system, such as Parkinson's disease and stroke, and some medicines, such as tricyclic antidepressants, calcium channel blockers, and opioid pain relievers. This condition can also be a complication of gastric surgery.

What are the symptoms?

The most common symptoms of gastroparesis are:

• A feeling of fullness after only a few bites of food.
• Nausea.
• Vomiting.
• Belly pain.
• Bloating.

Gastroparesis may be suspected in a person with diabetes who has upper digestive tract symptoms or has blood sugar levels that are hard to control. Controlling blood sugar levels may reduce symptoms of gastroparesis.

How is it diagnosed?

Your doctor will ask you questions about your symptoms and will do a physical exam. Your doctor may also need to do tests to check your stomach and digestion and to rule out other problems that may be causing your symptoms. Tests that may be done include:

• Gastric emptying scan. This test can show how quickly food leaves your stomach. A radioactive substance is included in a solid meal that you eat. It does not include enough radiation to harm you. This substance shows up on a special image, allowing a doctor to see food in your stomach and watch how quickly it leaves your stomach.
• Gastric or duodenal manometry. Manometry is a test that measures the strength and pattern of muscle contractions. This test may be done in the stomach (gastric manometry) or in the first part of the intestines (duodenal manometry).
• Upper gastrointestinal series.
• Upper gastrointestinal endoscopy.
• Wireless motility capsule study. In a capsule study, a special capsule is taken with a solid meal. The capsule can measure the time it takes for food to move through your digestive system as it passes out of your body.
• Breath test. This test may also be used for people who can't have the gastric emptying scan. In a breath test, a special supplement is taken with a solid meal. It is absorbed in the digestive system and part of it is exhaled. Breath tests taken at different times after the meal show how fast food moves through your digestive system.
• Blood tests.

How is gastroparesis treated?

You can make changes to your lifestyle to help relieve your symptoms of gastroparesis. Here are some things to try:

• Change your eating habits:
  • It's best to eat several small meals instead of two or three large meals. You may want to replace some solid meals with liquids (such as soup).
  • After you eat, wait 2 to 3 hours before you lie down.
  • Eat meals that are low in fiber and fat.
  • Relax before you start eating, and then eat slowly.
• If you have diabetes:
  • Carry a quick-sugar food that is absorbed in your mouth instead of your stomach (such as glucose tabs, gels, or hard candy) in case you need to treat low blood sugar.
  • Controlling your blood sugar levels may reduce your symptoms. Food can take longer to digest, which can make it harder to know when insulin will work after eating. This can lead to high and low blood sugars.

If you need help making changes to your diet, ask your doctor or a dietitian for help.

There are also medicines that can help with gastroparesis, including:

• Medicine to help with nausea and vomiting (antiemetics).
• Medicine to help the stomach empty more quickly (motility agents), such as metoclopramide (for example, Reglan) or erythromycin.

Changes to diet and medicines help most people who have gastroparesis. If that doesn't work, your doctor may have to try something else. At first, you may need to try a different medicine or take more than one medicine. Surgery to place a feeding tube in the small intestine may be needed for severe gastroparesis.