Gastroparesis

Gastroparesis is a long-term (chronic) condition where the stomach can't empty itself in the normal way. Food passes through the stomach more slowly than usual.

It's thought to be the result of a problem with the nerves and muscles controlling the emptying of the stomach.

If these nerves are damaged, the muscles of your stomach may not work properly and the movement of food can slow down.

Symptoms of gastroparesis

Symptoms of gastroparesis may include:

• feeling full very quickly when eating
• feeling sick (nausea) and vomiting
• loss of appetite
• weight loss
• bloating
• tummy (abdominal) pain or discomfort
• heartburn

These symptoms can be mild or severe, and tend to come and go.

When to seek medical advice

See your GP if you're experiencing symptoms of gastroparesis, as it can lead to some potentially serious complications.

These include:

• dehydration from repeated vomiting
• gastro-oesophageal reflux disease (GORD) – where stomach acid leaks out of your stomach and into your gullet
• malnutrition – when your body is not getting enough nutrients
• unpredictable blood sugar levels – this is a particular risk in people with diabetes

Causes of gastroparesis

In many cases of gastroparesis, there's no obvious cause. This is known as idiopathic gastroparesis.

Known causes of gastroparesis include:

• poorly controlled type 1 diabetes or type 2 diabetes
• a complication of some types of surgery – such as weight loss (bariatric) surgery or removal of part of the stomach (gastrectomy)

Other possible causes include:

• medication – such as opioid painkillers like morphine and some antidepressants
• Parkinson's disease – a condition in which part of the brain becomes progressively damaged over many years
• scleroderma – an uncommon disease that results in hard, thickened areas of skin, and sometimes problems with internal organs and blood vessels
• amyloidosis – a group of rare but serious diseases caused by deposits of abnormal protein in tissues and organs throughout the body

Diagnosing gastroparesis

To diagnose gastroparesis, your GP will ask about your symptoms and medical history, and may arrange some blood tests.

You may be referred to hospital for some of the following tests:

• bariumX-ray – where you swallow a liquid containing the chemical barium, which shows up on X-ray and highlights its passage through your digestive system
• gastric emptying scan using scintigraphy – you eat food (often eggs) containing a very small amount of a radioactive substance that is detected on the scan; gastroparesis is diagnosed if more than 10% of the food is still in your stomach four hours after eating
• wireless capsule test – you swallow a small, electronic device that sends information about how fast it moves through your digestive tract to a recording device
• endoscopy – a thin, flexible tube (endoscope) is passed down your throat and into your stomach to examine the stomach lining and rule out other possible causes

Treating gastroparesis

Gastroparesis can't usually be cured, but dietary changes and medical treatment can help you control the condition.

Dietary changes

You may find these tips helpful:

• instead of three meals a day, try smaller, more frequent meals – this means there's less food in your stomach and it will be easier to pass through your system
• try soft and liquid foods – these are easier to digest
• chew food well before swallowing
• drink non-fizzy liquids with each meal

It may also help to avoid certain foods that are hard to digest – such as apples with their skin on, or high-fibre foods like oranges and broccoli – as well as foods high in fat, which can also slow down digestion.

Medication

The following medications may be prescribed to help improve your symptoms:

• domperidone – which is taken before eating to contract your stomach muscles and help move food along
• erythromycin – an antibiotic that also helps contract the stomach and may help move food along
• anti-emetics – medication that controls nausea

However, the evidence that these medications relieve the symptoms of gastroparesis is relatively limited and they can cause a number of side effects. Your doctor should discuss the potential risks and benefits with you.

Domperidone should only be taken at the lowest effective dose for the shortest possible duration because of the small risk of potentially serious heart-related side effects.

Electrical stimulation

If dietary changes and medication don't improve your symptoms, a relatively new treatment called gastroelectrical stimulation may be tried. However, this is currently not routinely funded by many local NHS authorities.

Gastroelectrical stimulation involves surgically implanting a battery-operated device under the skin of your tummy.

Two leads attached to this device are fixed to the muscles of your lower stomach. They deliver electrical impulses to help stimulate the muscles involved in controlling the passage of food through your stomach. The device is turned on using a handheld external control.

The effectiveness of this treatment can vary considerably. Not everyone will respond to it, and for many of those who do the effect will largely wear off within 12 months. This means electrical stimulation isn't suitable for everyone with the condition.

There's also a small chance of this procedure leading to complications that would require removing the device, such as:

• infection
• the device dislodging and moving
• a hole forming in your stomach wall

Speak to your surgeon about the possible risks. You can also read the National Institute for Health and Care Excellence (NICE) guidelines on gastroelectrical stimulation for gastroparesis.

Botulinum toxin

More severe cases of gastroparesis may occasionally be treated by injecting botulinum toxin into the valve between your stomach and small intestine.

This relaxes the valve and keeps it open for a longer period of time so food can pass through.

The injection is given through an endoscope, which is passed down your throat and into your stomach.

This is a fairly new treatment and some studies have found it may not be very effective, so it's not recommended by all doctors.

A feeding tube

If you have extremely severe gastroparesis that isn't improved with dietary changes and medication, you may benefit from a feeding tube.

Many different types of temporary and permanent feeding tube are available.

A temporary feeding tube called a nasojejunal tube may be offered to you first, which is inserted through your nose to pass nutrients directly into your small intestine.

A feeding tube can also be inserted into your bowel surgically through a cut (incision) made in your tummy. This is known as a jejunostomy.

Liquid food containing nutrients can be fed through the tube, which goes straight to your bowel to be absorbed, bypassing your stomach.

Speak to your doctor about the risks and benefits of each type of feeding tube.

An alternative feeding method for severe gastroparesis is intravenous (parenteral) nutrition, where liquid nutrients are passed straight into your bloodstream through a catheter fed into a large vein.

Surgery

Some people may benefit from having an operation to insert a tube into the stomach through the tummy. This tube can be periodically opened to release gas and relieve bloating.

A surgical procedure may be recommended as a last resort to either:

• create a new opening between your stomach and small intestine (gastroenterostomy)
• connect your stomach directly to the second part of your small intestine, called the jejunum (gastrojejunostomy)

These procedures may reduce your symptoms by allowing food to move through your stomach more easily.

Your doctor can explain whether any procedures are suitable for you, and can discuss the possible risks involved.

Advice for people with diabetes

Having gastroparesis means your food is being absorbed slowly and at unpredictable times. If you also have diabetes, this can lead to wide swings in blood sugar levels.

The nerves to the stomach can be damaged by high levels of blood glucose, so it's important to keep your blood glucose levels under control if you have diabetes.

Your doctor can advise you about any changes you may need to make to your diet or medication.

If you're taking insulin, you may need to divide your dose before and after meals and inject into areas where absorption is typically slower, such as the thigh.

You'll also need to check your blood glucose levels frequently after you eat.

Read about living with diabetes.