Treatment for Gastroparesis

How do doctors treat gastroparesis?

How doctors treat gastroparesis depends on the cause, how severe your symptoms and complications are, and how well you respond to different treatments. Sometimes, treating the cause may stop gastroparesis. If diabetes is causing your gastroparesis, your health care professional will work with you to help control your blood glucose levels. When the cause of your gastroparesis is not known, your doctor will provide treatments to help relieve your symptoms and treat complications.

Changing eating habits

Changing your eating habits can help control gastroparesis and make sure you get the right amount of nutrients, calories, and liquids. Getting the right amount of nutrients, calories, and liquids can also treat the disorder’s two main complications: malnutrition and dehydration.

Your doctor may recommend that you

• eat foods low in fat and fiber
• eat five or six small, nutritious meals a day instead of two or three large meals
• chew your food thoroughly
• eat soft, well-cooked foods
• avoid carbonated, or fizzy, beverages
• avoid alcohol
• drink plenty of water or liquids that contain glucose and electrolytes, such as
  • low-fat broths or clear soups
  • naturally sweetened, low-fiber fruit and vegetable juices
  • sports drinks
  • oral rehydration solutions
• do some gentle physical activity after a meal, such as taking a walk
• avoid lying down for 2 hours after a meal
• take a multivitamin each day

If your symptoms are moderate to severe, your doctor may recommend drinking only liquids or eating well-cooked solid foods that have been processed into very small pieces or paste in a blender.

Controlling blood glucose levels

If you have gastroparesis and diabetes, you will need to control your blood glucose levels, especially hyperglycemia. Hyperglycemia may further delay the emptying of food from your stomach. Your doctor will work with you to make sure your blood glucose levels are not too high or too low and don’t keep going up or down. Your doctor may recommend

• taking insulin more often, or changing the type of insulin you take
• taking insulin after, instead of before, meals
• checking your blood glucose levels often after you eat, and taking insulin when you need it

Your doctor will give you specific instructions for taking insulin based on your needs and the severity of your gastroparesis.

Medicines

Your doctor may prescribe medicines that help the muscles in the wall of your stomach work better. He or she may also prescribe medicines to control nausea and vomiting and reduce pain.

Your doctor may prescribe one or more of the following medicines:

• Metoclopramide. This medicine increases the tightening, or contraction, of the muscles in the wall of your stomach and may improve gastric emptying. Metoclopramide may also help relieve nausea and vomiting.
• Domperidone. This medicine also increases the contraction of the muscles in the wall of your stomach and may improve gastric emptying. However, this medicine is available for use only under a special program administered by the U.S. Food and Drug Administration.
• Erythromycin. This medicine also increases stomach muscle contraction and may improve gastric emptying.
• Antiemetics. Antiemetics are medicines that help relieve nausea and vomiting. Prescription antiemetics include ondansetron , prochlorperazine , and promethazine.  Over-the-counter antiemetics include bismuth subsalicylate  and diphenhydramine . Antiemetics do not improve gastric emptying.
• Antidepressants. Certain antidepressants, such as mirtazapine, may help relieve nausea and vomiting. These medicines may not improve gastric emptying.
• Pain medicines. Pain medicines that are not narcotic pain medicines may reduce pain in your abdomen due to gastroparesis.

Oral or nasal tube feeding

In some cases, your doctor may recommend oral or nasal tube feeding to make sure you’re getting the right amount of nutrients and calories. A health care professional will put a tube either into your mouth or nose, through your esophagus and stomach, to your small intestine. Oral and nasal tube feeding bypass your stomach and deliver a special liquid food directly into your small intestine.

Jejunostomy tube feeding

If you aren’t getting enough nutrients and calories from other treatments, your doctor may recommend jejunostomy tube feeding. Jejunostomy feedings are a longer term method of feeding, compared to oral or nasal tube feeding.

Jejunostomy tube feeding is a way to feed you through a tube placed into part of your small intestine called the jejunum. To place the tube into the jejunum, a doctor creates an opening, called a jejunostomy, in your abdominal wall that goes into your jejunum. The feeding tube bypasses your stomach and delivers a liquid food directly into your jejunum.

Parenteral nutrition

Your doctor may recommend parenteral, or intravenous (IV), nutrition if your gastroparesis is so severe that other treatments are not helping. Parenteral nutrition delivers liquid nutrients directly into your bloodstream. Parenteral nutrition may be short term, until you can eat again. Parenteral nutrition may also be used until a tube can be placed for oral, nasal, or jejunostomy tube feeding. In some cases, parental nutrition may be long term.

Venting gastrostomy

Your doctor may recommend a venting gastrostomy to relieve pressure inside your stomach. A doctor creates an opening, called a gastrostomy, in your abdominal wall and into your stomach. The doctor then places a tube through the gastrostomy into your stomach. Stomach contents can then flow out of the tube and relieve pressure inside your stomach.

Gastric electrical stimulation

Gastric electrical stimulation (GES) uses a small, battery-powered device to send mild electrical pulses to the nerves and muscles in the lower stomach. A surgeon puts the device under the skin in your lower abdomen and attaches wires from the device to the muscles in the wall of your stomach. GES can help decrease long-term nausea and vomiting.

GES is used to treat people with gastroparesis due to diabetes or unknown causes only, and only in people whose symptoms can’t be controlled with medicines.

How can I prevent gastroparesis?

Gastroparesis without a known cause, called idiopathic gastroparesis, cannot be prevented.

If you have diabetes, you can prevent or delay nerve damage that can cause gastroparesis by keeping your blood glucose levels within the target range that your doctor thinks is best for you. Meal planning, physical activity, and medicines, if needed, can help you keep your blood glucose levels within your target range.