Gastroparesis

Understanding Gastroparesis

With gastroparesis, the muscles of the stomach do not work properly. They don't break up food and move it to the small intestine where nutrient absorption normally takes place.

It is more common among women and is one of several disorders relating to muscle movements that carry food through the digestive system.

Untreated, it can lead to dehydration, malnutrition and bezoars (hardened masses of food that can block the digestive tract).

Symptoms

Symptoms of gastroparesis can include:

• Nausea
• Vomiting
• Weight loss
• Bloating
• Heartburn
• Pain in the upper abdomen

Cause

Gastroparesis can develop when the vagus nerve, which controls the stomach muscles, becomes damaged.

Diabetes most commonly causes this condition. It also makes diabetes management more challenging. That's because it causes food to leave the stomach at unpredictable times. When food finally does enter the small intestine, it increases blood sugar.

Other causes include:

• Certain types of surgery, including gastrectomy (removal of part of the stomach)
• Systemic sclerosis (autoimmune disorder affecting the skin and internal organs)
• Nervous system disorders, including Parkinson’s disease and multiple sclerosis

In many cases, physicians cannot find a cause.

Treatment

Gastroparesis affects each person differently. IU Health physicians develop treatment plans based on your specific symptoms, needs and goals. Although no cure exists, your physicians provide effective treatment to relieve your symptoms and help you get proper nutrition.

Your healthcare team includes experienced specialists in the following areas:

• GI motility
• Minimally invasive surgery
• Intestinal transplant surgery
• Neurology
• Medical genetics
• GI radiology
• GI neuromuscular pathology and nutrition.

Your team’s close relationship with Indiana University School of Medicine, allows them to conduct research to improve care. They offer clinical trials of new treatments.

Treatment options for gastroparesis include:

• Dietary changes. Adjusting your eating habits can help you control your symptoms. We work with you to design a diet that gives you the nutrients you need while helping you stay as comfortable and active as possible.
• Medicine. Several medicines can improve emptying of the stomach and reduce symptoms. Erythromycin and metoclopramide (in tablet, liquid and IV forms) promote muscle activity in the stomach. Promethazine and prochlorperazine, can help control nausea and vomiting.
• Gastric electrical stimulation. This treatment uses a device to deliver mild electrical pulses to the stomach muscles. This may help if your nausea and vomiting have not improved with dietary changes and medicine. A surgeon places the stimulator (gastric pacemaker) under the skin of the abdomen and two lead wires connect it to the stomach muscles. For some patients, they perform a temporary version of it to see if it works for you before performing surgery. IU Health has one of only a few centers in the country offering temporary gastric electrical stimulation for children and adults.
• Surgery. If other treatments do not work your physician may perform a surgical procedure called jejunostomy where he/she places a tube in the abdominal wall through which you receive a liquid food mixture. The tube connects to the small intestine, allowing nutrition to bypass the stomach. Several other less common surgical procedures include pyloroplasty (a procedure to make a larger opening at the bottom of the stomach) and gastrectomy (removal of the stomach).
• Parenteral nutrition. This treatment delivers nutrition directly into the bloodstream, bypassing your digestive tract, in cases of severe gastroparesis. Parenteral nutrition often provides a temporary treatment to help you recover after a period of dehydration and malnutrition, but can also provide long-term therapy.
• Diabetes management. If you have gastroparesis related to diabetes, your physician may recommend adjusting your blood sugar management. Possible changes include taking insulin more often, using a different type of insulin and taking insulin after meals, rather than before.