Gastroparesis

Diagnosis

Several tests help diagnose gastroparesis and rule out other conditions that may cause symptoms like those of gastroparesis. Tests may include:

Gastric emptying tests

To see how fast your stomach empties, you may have one or more of these tests:

• Scintigraphy. This is the main test used to diagnose gastroparesis. It involves eating a light meal, such as eggs and toast, that has a small amount of radioactive material in it. A scanner follows the movement of the radioactive material. The scanner goes over the belly to show the rate at which food leaves the stomach.

  This test takes about four hours. You'll need to stop taking any medicines that could slow gastric emptying. Ask your healthcare professional what not to take.

• Breath tests. For breath tests, you consume a solid or liquid food that has a substance that your body absorbs. In time, the substance shows up in your breath.

  Your healthcare team collects samples of your breath over a few hours to measure the amount of the substance in your breath. The amount of substance in your breath shows how fast your stomach empties.

Upper gastrointestinal (GI) endoscopy

This procedure is used to see the tube that connects the throat to the stomach, called the esophagus, the stomach and beginning of the small intestine, called the duodenum. It uses a tiny camera on the end of a long, flexible tube.

This test also can diagnose other conditions that can have symptoms like those of gastroparesis. Examples are peptic ulcer disease and pyloric stenosis.

Ultrasound

This test uses high-frequency sound waves to make images of structures within the body. Ultrasound can help diagnose whether problems with the gallbladder or kidneys could be causing symptoms.

Treatment

Treating gastroparesis begins with finding and treating the condition that's causing it. If diabetes is causing your gastroparesis, your healthcare professional can work with you to help you control your blood sugar levels.

Changes to your diet

Getting enough calories and nutrition while improving symptoms is the main goal in the treatment of gastroparesis. Many people can manage gastroparesis with dietary changes. Your healthcare professional may refer you to a specialist, called a dietitian.

A dietitian can work with you to find foods that are easier to digest. This can help you get enough nutrition from the food you eat.

A dietitian might have you try to the following:

• Eat smaller meals more often.
• Chew food well.
• Eat well-cooked fruits and vegetables rather than raw fruits and vegetables.
• Don't eat fruits and vegetables with a lot of fiber, such as oranges and broccoli. These can harden into a solid mass that stays in the stomach, called a bezoar.
• Choose mostly low-fat foods. If eating fat doesn't bother you, add small servings of fatty foods to your diet.
• Eat soups and pureed foods if liquids are easier for you to swallow.
• Drink about 34 to 51 ounces (1 to 1.5 liters) of water a day.
• Exercise gently, such as by taking a walk, after you eat.
• Don't drink fizzy drinks, called carbonated drinks, or alcohol.
• Don't smoke.
• Don't lie down for two hours after a meal.
• Take a multivitamin daily.
• Don't eat and drink at the same time. Space them out by about an hour.

Ask your dietitian for a list of foods suggested for people with gastroparesis.

Medications

Medicines to treat gastroparesis may include:

• Medicines to help the stomach muscles work. Metoclopramide is the only medicine the U.S. Food & Drug Administration (FDA) has approved for the treatment of gastroparesis. The metoclopramide pill (Reglan) has a risk of serious side effects.

  But the FDA recently approved a metoclopramide nasal spray (Gimoti) for treating diabetic gastroparesis. The nasal spray has fewer side effects than the pill.

  Another medicine that helps the stomach muscles work is erythromycin. It may work less well over time. And it can cause side effects such as diarrhea.

  There's a newer medicine, domperidone, that eases symptoms of gastroparesis. But the FDA doesn't approve the medicine except when other treatments have failed. To prescribe the medicine, healthcare professionals must apply to the FDA.

• Medicines to control nausea and vomiting. Drugs that help ease nausea and vomiting include diphenhydramine (Benadryl) and ondansetron. Prochlorperazine (Compro) is for nausea and vomiting that don't go away with other medicines.

Surgical treatment

Some people with gastroparesis may be unable to have any food or liquids. Then healthcare professionals may suggest that a feeding tube, called a jejunostomy tube, be placed in the small intestine. Another choice is a gastric venting tube to help relieve pressure from gastric contents.

Feeding tubes can be passed through the nose or mouth or directly into the small intestine through the skin. Most often, the tube is placed for the short term. A feeding tube is only for gastroparesis that's severe or when no other method controls blood sugar levels. Some people may need a feeding tube that goes into a vein in the chest, called an intravenous (IV) feeding tube.

Treatments under study

Researchers keep looking at new medicines and procedures to treat gastroparesis.

One new medicine in development is called relamorelin. The results of a phase 2 trial found that the drug could speed up gastric emptying and ease vomiting. The FDA has not yet approved the medicine, but study of it is ongoing.

Researchers also are studying new therapies that involve a slender tube, called an endoscope. The endoscope goes into the esophagus.

One procedure, known as endoscopic pyloromyotomy, involves making a cut in the muscular ring between the stomach and small intestine. This muscular ring is called the pylorus. It opens a channel from the stomach to the small intestine. The procedure also is called gastric peroral endoscopic myotomy (G-POEM). This procedure shows promise for gastroparesis. More study is needed.

Gastric electrical stimulation

In gastric electrical stimulation, a device that's put into the body with surgery gives electrical stimulation to the stomach muscles to move food better. Study results have been mixed. But the device seems to be most helpful for people who have diabetes and gastroparesis.

The FDA allows the device to be used for those who can't control their gastroparesis symptoms with diet changes or medicines. Larger studies are needed.

Clinical trials

Explore Mayo Clinic studies testing new treatments, interventions and tests as a means to prevent, detect, treat or manage this condition.

Lifestyle and home remedies

If you smoke, stop. Your gastroparesis symptoms are less likely to improve over time if you keep smoking.

Alternative medicine

Some alternative therapies have been used to treat gastroparesis, including acupuncture. Acupuncture involves putting very thin needles through the skin at certain points on the body. During a treatment called electroacupuncture, a small electrical current is passed through the needles. Studies have shown that these treatments may ease gastroparesis symptoms more than a sham treatment does.

Preparing for your appointment

You're likely to first see your main healthcare professional. You may then be sent to a doctor who specializes in digestive diseases, called a gastroenterologist. You also may see a specialist called a dietitian who can help you choose foods that are easier to digest.

What you can do

When you make the appointment ask if there's anything you need to do before, such as restrict your diet or stop using certain medicines. Take a family member or friend to the appointment, if possible, to help you remember the information you get.

Make a list of:

• Your symptoms. Include any that don't seem linked to the reason for your appointment and when they began.
• Key personal information. Include other medical conditions you have and recent life changes and major stresses.
• All medicines, vitamins or supplements you take. Include the doses and how often you take them.
• Questions to ask your healthcare team.

For gastroparesis, some basic questions to ask include:

• What's the most likely cause of my symptoms?
• What tests do I need?
• Is this condition likely to be long lasting?
• What treatments do you suggest?
• Are there certain foods I can eat that are easier to digest?
• I have other health conditions. How can I manage these conditions together?
• Are there brochures or other printed material that I can have? What websites do you suggest?

Be sure to ask all the questions you have.

What to expect from your doctor

Your healthcare professional might ask you:

• Do your symptoms come and go, or do you always have them?
• How bad are your symptoms?
• Does anything seem to make your symptoms better or worse?
• Did your symptoms start all of a sudden, such as after having food poisoning?
• What surgeries have you had?