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GASTROPARESIS

Gastroparesis is diagnosed when an individual’s stomach is found to empty slowly.  Common symptoms include early satiety, bloating after eating, nausea and vomiting. Due to the slow emptying individuals will often eat only an average or small meal and yet feel that they have eaten a ‘Thanksgiving dinner’. Bloating increases over the day as more and more is eaten. Often, an individual will feel better first thing in the morning as the stomach has had an entire night to empty.

Causes

Diabetes is a common cause, medications can sometimes slow down stomach emptying (i.e. narcotics), up to 50% of individuals have no clear cause.  Some individuals can have a connective tissue disorder (i.e. Scleroderma) or it can occur after a viral infection of the gut.

Diagnosis

Gastroparesis can sometimes be made at gastroscopy; if an individual has been fasting for a gastroscopy and there is still a considerable amount of food in the stomach this tells us that their stomach empties slowly. Another investigation is the Stomach Emptying Test, during which the individual ingests an egg sandwich that has been radio-labeled.  Special equipment is then used to monitor how slowly or quickly the egg sandwich empties out of the stomach. If this test does show slow stomach emptying this supports a diagnosis of Gastroparesis. Unfortunately, this test is not as sensitive as we would like, and sometimes individuals with a mild case will not be decected.

Treatment

Once a diagnosis of Gastroparesis is made, the patient should eat frequent, smaller meals. Eating a traditional three meals/day often does not give the stomach enough time to empty. Individuals often do better ‘grazing’, or by eating six or more small meals per day,  giving the stomach more of an opportunity to empty.  In Gastroenterology we often encourage patients to eat high-fiber foods—individuals with Gastroparesis, however, often find that high-roughage foods such as salad will make them feel worse. On ‘bad days’ they will feel better if they stick to a liquid diet  such as soups.

Medication

Domperidone, also known as Motilium, often helps individuals with Gastroparesis. This medication helps the stomach to empty better.  Individuals will often continue to notice an improvement up to a month after beginning Domperidone/Motilium.  It is important, therefore, not to give up in a few weeks because you do not feel better yet. It can be a full month before you see an effect. The medication is usually taken before meals and before going to bed. Sometimes when you are about to start eating you realize you have forgotten to take the Domperidone—if this happens, take the Domperidone at that time.  If you skip a meal, take the Domperidone when you would normally eat that meal. It is important to take your dosage regularly, because if you do not there will not be high enough levels of the Domperidone in your blood and it is less likely to work.

Unfortunately, symptoms do not always entirely resolve, but there is often improvement. A 50% improvement is considered good; more improvement than that is excellent.

Erythromycin is an antibiotic that often causes diarrhea in individuals; It has been studied and found to increase stomach emptying. Although the evidence supporting its use is weak, there are some patients who do benefit from it.  

If the above medications are not effective and there is a significant component of nausea and/or vomiting, often anti-emetics (anti-nausea medications) including Gravol or Ondansetron can be tried.