Gastroparesis

Treatment

Mayo doctors work with patients to create an individualized treatment plan, adapting it as symptoms change or as better treatment options become available. In patients with diabetes or other disorders, treatment begins with addressing the underlying disorder. In general, dietary modification is the main strategy, along with medication for patients with severe symptoms. A newer treatment is gastric neurostimulation.

Dietary modification

Dietary modification usually begins with a 'gastroparetic diet' that includes:

• More frequent, smaller meals
• Low-fat and low-fiber foods (fat slows digestion and fiber is difficult to break down)
• Soft foods

If these changes are not sufficient, then pureeing food, shifting to a more liquid diet or other strategies may be necessary. Patients are referred to a dietitian specializing in this disorder.

Medication

When dietary modification doesn't provide sufficient relief, medications may be tried. They don't work for all patients, however, and some can have serious side effects.

Prokinetics

Metoclopramide (Reglan) stimulates muscle contractions in the stomach. It can cause drowsiness and tremors.

Antibiotics

The antibiotic erythromycin can produce short bursts of strong stomach contractions, but patients develop a resistance to it over time, and serious side effects can occur. At Mayo Clinic, erythromycin tends tobe used intravenously to "kick-start" a patient's digestion during hospitalization.

Gastric Neurostimulation

In neurostimulation, a device implanted in the abdomen delivers an electric current to stimulate stomach contractions. It may be an option for patients with very severe symptoms; however, it's still experimental and not an option for every patient (not for pregnant women, for example).

Feeding Tube

In cases where the stomach does not function because of gastroparesis, Mayo doctors sometimes insert a tube into the small intestine (jejunostomy) to deliver food. At Mayo, this tube is inserted with the aid of an endoscope. Mayo doctors reported a 69 percent success rate using this technique in a series of 286 patients. They found that complications occurred in 22 percent of cases. They concluded that the technique is useful and obviates the need for surgery, but that it carries risks. See report in PubMed.

Surgery

Surgery may be an option in extremely severe cases when other treatments haven't helped. Mayo Clinic has surgeons experienced in various forms of bypassing or removing part or all of the stomach. This option is rarely used.