Gastroparesis

How common is gastroparesis?

It is not known exactly how common gastroparesis is because there may be many people who are not diagnosed, especially if their symptoms are relatively mild. One study in the USA found that 1 in 10,000 men and 4 in 10,000 women had gastroparesis but this may be an underestimate.

Gastroparesis can affect people of all ages but it is more common in older age groups and also more common in women.

What causes gastroparesis?

For many people with gastroparesis, there's no obvious cause. This is called idiopathic gastroparesis. The most common cause is diabetes, especially poorly controlled diabetes. Over time, diabetes can cause damage to the stomach nerves. This is called diabetic gastroparesis. Gastroparesis can occur in type 1 diabetes or type 2 diabetes.

Gastroparesis may also occur:

• Following a viral or bacterial infection.

• After some types of surgery - eg, weight loss surgery or removal of part of your stomach (partial gastrectomy).

• As a side-effect of various medicines - eg, strong painkillers (opioids) or tricyclic antidepressants.

• In some neurological conditions such as multiple sclerosis, Parkinson's disease, or following a stroke.

• As a result of having an underactive thyroid gland (hypothyroidism).

• In a number of rare conditions such as systemic sclerosis or amyloidosis.

Gastroparesis symptoms

Gastroparesis symptoms vary from mild to severe and often tend to come and go. Many people with mild gastroparesis are not aware of any symptoms.

Usually a number of symptoms occur together rather than having just one symptom. The symptoms of gastroparesis may include:

• Feeling full after few mouthfuls of a normal-sized meal (early satiety) and being unable to finish a meal.

• Feeling sick (nausea). Vomiting undigested food eaten a few hours earlier.

• Loss of appetite.

• Weight loss.

• Bloating.

• Belching.

• Tummy (abdominal) pain or discomfort.

• Heartburn. This can also occur, due to the stomach emptying slowly.

Gastroparesis symptoms are sometimes very similar to other conditions such as indigestion (dyspepsia), food intolerance, stomach acid reflux, cyclical vomiting syndrome, chronic pancreatitis, and other causes of nausea and vomiting.

What are the tests for gastroparesis?

If it is suspected that you might have gastroparesis, your doctor will refer you to a hospital specialist. You may need one or more of the following tests:

Barium meal

If you are asked to undergo a barium meal test, you swallow a liquid containing barium. This is then seen on an X-ray and highlights how the liquid is passing through your digestive system.

Gastric emptying scintigraphy (GES)

You eat a solid meal (usually scrambled egg with bread). The meal contains a small amount of a radioactive substance (called an isotope). The isotope disappears from your body very quickly but allows the progress of the meal to be monitored, using a special external camera, to see how long it takes for the food to progress through your stomach. This test is very useful to help diagnose gastroparesis. However, an abnormal GES result does not necessarily mean you have gastroparesis.

Stable isotope breath test

This involves either a solid or liquid meal, which again includes a small amount of an isotope. This isotope is converted to carbon dioxide gas in your body and the amount of carbon dioxide gas is then measured in your breath. This test can show how fast your stomach empties after eating food.

Gastroscopy

If you undergo the test known as a gastroscopy, a thin, flexible tube with a tiny camera (endoscope) is passed down your throat and into your stomach to examine the stomach lining and rule out other possible causes for gastroparesis symptoms. In gastroparesis the test result is usually normal.

Ultrasound scan or MRI

Scans called ultrasound and MRI may may also be used to look for other possible causes for your symptoms.

Gastroparesis treatment

Gastroparesis cannot usually be cured, but dietary changes and medical treatment can help you control your symptoms.

Dietary advice

• Eat smaller, more frequent meals.

• Eat soft and liquid foods, as these are easier to digest.

• Avoid tough fibrous foods, such as raw vegetables, broccoli, celery, citrus fruits, apples with their skin, oranges, pumpkin, grapes, prunes and raisins.

• Chew food well before swallowing.

• Drink liquids with each meal, but avoid fizzy drinks.

• Avoid foods that are high in fat, which can also slow down digestion.

• Following eating any meal, wait for at least two hours before lying down.

If you need any major changes to your diet, your doctor will refer you to a dietician to make sure your diet still provides all the essential nutrients you need. Your doctor may also prescribe oral nutrition supplements to help get essential nutrients and calories into your body if you are unable to eat much solid food.

Improving control of high blood sugars is very important for people who have diabetes and have been diagnosed with diabetic gastroparesis. See also the separate leaflets on Type 1 Diabetes and Type 2 Diabetes for more information.

Medicines

Medicines can be used to help reduce gastroparesis symptoms. The medicines include:

• Medications to stimulate the stomach muscles. These medications include domperidone, metoclopramide and erythromycin.

• Medications to control nausea and vomiting. Drugs that help ease nausea and vomiting include ondansetron and prochlorperazine. Domperidone and metoclopramide also help to control nausea and vomiting.

Gastric electrical stimulation

If dietary changes and medicine do not help your symptoms, a treatment called gastric electrical stimulation may be recommended.

This treatment involves a minor surgical procedure to implant a battery-operated device under the skin of your tummy. Two leads attached to this device are fixed to the muscles of your lower stomach. They send electrical impulses to help stimulate the muscles involved in controlling the passage of food through your stomach. The device is turned on using a handheld external control.

The effectiveness of this treatment is very variable and it is not suitable for everyone with gastroparesis. The treatment may not be effective for you. For many people who do respond, the benefit will only last for up to 12 months.

There is also a small chance that this treatment may cause complications that mean the device has to be removed. The possible complications include:

• Infection.

• The device dislodging and moving.

• A hole forming in your stomach wall.

The National Institute for Health and Care Excellence (NICE) recommends that the evidence for the benefit and safety of gastric electrical stimulation for gastroparesis is adequate to support the use of the procedure. However, they do highlight that some patients do not get any benefit from it.

Botulinum toxin injections

If you have severe gastroparesis then injecting botulinum toxin into the valve between your stomach and small intestine may be considered. This relaxes the valve and keeps it open for a longer period of time so that food can pass through.

The injection is given through a thin, flexible tube (endoscope) which is passed down your throat and into your stomach. The benefit of this treatment is also variable and some studies have found it may not be very effective.

Surgery

Surgery may be recommended if all other treatments have not helped. These operations are designed to reduce gastroparesis symptoms by allowing food to move through your stomach more easily. The options for surgery include:

• Creating an opening between your stomach and small intestine (gastroenterostomy). A small tube (stent) is used to keep this connection open.

• Connecting your stomach directly to the second part of your small intestine, called the jejunum (gastrojejunostomy).

• Some people may benefit from having an operation to insert a tube into the stomach through the tummy (abdomen). This tube can be opened at intervals to release gas and relieve bloating.

Feeding tube

If you have extremely severe gastroparesis that is not improved with any treatment, a feeding tube may be recommended. There are many different types of temporary and permanent feeding tube.

A temporary feeding tube, called a nasojejunal tube, may be tried first. This delivers nutrients directly into your small intestine. A thin tube is passed through your nose, down your throat, through you stomach and into your gut (small intestine).

A feeding tube can also be inserted into your bowel through a cut (incision) made in your tummy. This is known as a jejunostomy. Liquid food can be delivered through the tube and straight to your bowel to be absorbed into your body without having to go through your stomach. This is similar to a percutaneous endoscopic gastrostomy (PEG) feeding tube, where the tube goes into your stomach, but a PEG would be pointless for gastroparesis because of the problem with your stomach not emptying properly, and so the tube has to go straight to your bowel for gastroparesis.

An alternative feeding method for severe gastroparesis is intravenous (parenteral) nutrition. This allows liquid nutrients to be delivered into your bloodstream through a catheter inserted into a large vein. This route of feeding would only be used if there is also a problem with your gut (small intestine) as well as gastroparesis.

Other treatments

Other treatments which may be considered include gastric peroral endoscopy myotomy (G-POEM). A thin tube with a camera is inserted though your mouth and passed to your stomach. A muscle in your stomach is then cut, to help your stomach empty more easily.

Gastroparesis complications

Gastroparesis can lead to some potentially serious complications. These complications include:

• Dehydration as a result of repeated vomiting.

• Malnutrition, when your body is not getting enough nutrients. This can vary from mild to severe.

• Acid reflux.

• Unpredictable blood sugar levels in people with diabetes.

• Long-term symptoms can badly affect your quality of life and may lead to depression.

Outcome

Gastroparesis symptoms may improve over time (usually this takes at least 12 months) for some people, particularly those with gastroparesis after an infection.

If you have gastroparesis due to any cause other than infection then the outlook (prognosis) is more variable. However, the treatments outlined above can be very effective and so reduce your symptoms and improve your quality of life.