Treatment

Treating gastroparesis begins with identifying and treating the underlying condition. If diabetes is causing your gastroparesis, your doctor can work with you to help you control it.

Changes to your diet

Maintaining adequate nutrition is the most important goal in the treatment of gastroparesis. Many people can manage gastroparesis with diet changes and dietary changes are the first step in managing this condition. Your doctor may refer you to a dietitian who can work with you to find foods that are easier for you to digest so that you're more likely to get enough calories and nutrients from the food you eat. A dietitian might suggest that you try to:

  • Eat smaller meals more frequently
  • Chew food thoroughly
  • Eat well-cooked fruits and vegetables rather than raw fruits and vegetables
  • Avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars
  • Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet
  • Try 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 after you eat, such as going for a walk
  • Avoid carbonated drinks, alcohol and smoking
  • Try to avoid lying down for 2 hours after a meal
  • Take a multivitamin daily

Here's a brief list of foods recommended for people with gastroparesis (your dietitian can give you a more comprehensive list):

Starches

  • White bread and rolls and "light" whole-wheat bread without nuts or seeds
  • Plain or egg bagels
  • English muffins
  • Flour or corn tortillas
  • Pancakes
  • Puffed wheat and rice cereals
  • Cream of wheat or rice
  • White crackers
  • Potatoes, white or sweet (no skin)
  • Baked french fries
  • Rice
  • Pasta

Protein

  • Lean beef, veal and pork (not fried)
  • Chicken or turkey (no skin and not fried)
  • Crab, lobster, shrimp, clams, scallops, oysters
  • Tuna (packed in water)
  • Cottage cheese
  • Eggs
  • Tofu
  • Strained meat baby food

Fruits and vegetables

  • Baby food vegetables and fruits
  • Tomato sauce, paste, puree, juice
  • Carrots (cooked)
  • Beets (cooked)
  • Mushrooms (cooked)
  • Vegetable juice
  • Vegetable broth
  • Fruit juices and drinks
  • Applesauce
  • Bananas
  • Peaches and pears (canned)

Dairy

  • Milk, if tolerated
  • Yogurt (without fruit pieces)
  • Custard and pudding
  • Frozen yogurt

Medications

Medications to treat gastroparesis may include:

  • Medications to stimulate the stomach muscles. These medications include metoclopramide (Reglan) and erythromycin (Eryc, E.E.S.). Metoclopramide has a risk of serious side effects. Erythromycin may lose its effectiveness over time, and can cause side effects, such as diarrhea.

    A newer medication, domperidone, with fewer side effects, is also available with restricted access.

  • Medications to control nausea and vomiting. Drugs that help ease nausea and vomiting include prochlorperazine (Compro) and diphenhydramine (Benadryl, Unisom). A class of medications that includes ondansetron (Zofran) is sometimes used to help nausea and vomiting.

Surgical treatment

Some people with gastroparesis may be unable to tolerate any food or liquids. In these situations, doctors may recommend a feeding tube (jejunostomy tube) be placed in the small intestine. Or doctors may recommend a gastric venting tube to help relieve pressure from gastric contents.

Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. The tube is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can't be controlled by any other method. Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest.

Treatments under investigation

Researchers are continuing to investigate new medications to treat gastroparesis.

One example is a new drug in development called Relamorelin. The results of a phase 2 clinical trial found the drug could speed up gastric emptying and reduce vomiting. The drug is not yet approved by the Food and Drug Administration (FDA), but a larger clinical trial is currently underway.

A number of new therapies are being tried with the help of endoscopy — a slender tube that's threaded down the esophagus. One procedure used endoscopy to place a small tube (stent) where the stomach connects to the small intestine (duodenum) to keep this connection open.

Several research trials investigated the use of botulinum toxin administered through endoscopy without much success. This treatment is not recommended.

Doctors are also studying the use of a minimally invasive surgical technique when someone needs a feeding tube placed directly into the small intestine (jejunostomy tube).

Gastric electrical stimulation and pacing

Gastric electrical stimulation is a surgically implanted device that provides electrical stimulation to stimulate stomach muscles to move food more efficiently. Study results have been mixed. However, the device seems to be most helpful for people with diabetic gastroparesis.

The FDA allows the device to be used under a compassionate use exemption for those who can't control their gastroparesis symptoms with diet changes or medications. However, larger studies are needed.

Gastric pacing also involves a surgically implanted device that stimulates the stomach muscles, but this device tries to more closely mimic normal stomach contractions. Currently, the device is too large and causes discomfort. Gastric pacing devices are only available in clinical trials right now.

Alternative medicine

There is some evidence that certain alternative treatments can be helpful to people with gastroparesis, although more studies are needed. Some treatments that look promising include:

  • Acupuncture and electroacupuncture. Acupuncture involves the insertion of extremely thin needles through your skin at strategic points on your body. During electroacupuncture, a small electrical current is passed through the needles. Studies have shown these treatments to ease gastroparesis symptoms more than a sham treatment.
  • STW 5 (Iberogast). This herbal formula from Germany contains nine different herbal extracts. It hasn't been shown to speed up gastric emptying, but was slightly better at easing digestive symptoms than a placebo.
  • Rikkunshito. This Japanese herbal formula also contains nine herbs. It may help reduce abdominal pain and the feeling of post-meal fullness.
  • Cannabis. There aren't any published clinical trials on cannabis and gastroparesis. However, cannabis — commonly known as marijuana — is thought to ease nausea and other digestive complaints. Derivatives of cannabis have been used by people who have cancer in the past, but there are better FDA-approved medications available to control nausea now.

    Because cannabis is often smoked, there's concern about possible addiction and harm, similar to what occurs with tobacco smoke.

    In addition, daily users of marijuana (cannabis) may develop a condition that mimics the symptoms of gastroparesis called cannabis hyperemesis syndrome. Symptoms can include nausea, vomiting and abdominal pain. Quitting cannabis may help.