Treatment of Gastroparesis


Treatment of gastroparesis includes diet, medication, and therapies that helps in emptying of the stomach.

September 8, 2017

Treatment of gastroparesis includes diet, medication, and therapies that helps in emptying of the stomach. The goals of treatment include:

  • To choose a diet that contains foods which can be easily emptied from the stomach.
  • Controlling underlying conditions which are cause of gastroparesis.
  • Relieve symptoms of nausea, vomiting, and abdominal pain.
  • Stimulate muscle activity in the stomach so that food is properly ground and emptied from the stomach
  • Maintaining adequate nutrition.

Diet:

Diet is one of the most important thing to be taken care for the treatment of gastroparesis. The most important goal in the treatment of gastroparesis is to maintaining adequate nutrition. You can manage gastroparesis with some dietary changes .

  • When there is less food to empty,emptying from the stomach is faster. So eat smaller meals more frequently.
  • Food should be chewed thoroughly since the grinding action of the stomach is reduced. 
  • Well-cooked fruits and vegetables rather than raw fruits and vegetables should be eaten.
  • Some foods are more difficult than others for the stomach to digest. Fatty and fibrous foods take a longer time to digest.
  • People with gastroparesis should reduce their intake of fiber or avoid these foods.
  • Thick and thin liquids such as  pudding and nutrient drinks are easier for you to swallow.
  • Meals should be accompanied with enough liquids to ensure maximal liquidity of contents in the stomach since liquids usually empty better than solid food.
  • Going for a walk after you eat will help digesting the food.
  • Avoid carbonated drinks, alcohol and smoking
  • Try to avoid lying down for 2 hours after a meal,since when lying, the assistance of gravity on gastric emptying is lost.
  • Take a multivitamin daily to avoid malnutrition and vitamin and mineral deficiencies.


Controlling Underlying Conditions:

  • Control blood glucose levels in patients with diabetes to near normal levels with diets and medications as high levels of glucose in blood tends to slow gastric emptying.
  • Hypothyroidism should be treated with thyroid hormon as this impacts the process of digestion .
  • If bezoars are present, they should be removed .


Medications for Treating Gastroparesis:

Medications to treat gastroparesis includes:

metoclopramide (Reglan) and erythromycin (Eryc, E.E.S.) can be used for this purpose. However both of these medicines have serious side effects. Domperidone, with fewer side effects, is also available with restricted access.

Medications to control nausea, vomiting and abdominal pain:

Prochlorperazine (Compro) and diphenhydramine (Benadryl, Unisom) can be used for treating nausea and vomiting.
Ibuprofen (Motrin) and naproxen (Aleve), low dose tricyclic antidepressants such as amitriptyline (Elavil, Endep) can be used to relieve from abdominal pain.

Surgical Treatment:

Surgery for gastroparesis should be considered for the person with severe and refractory symptoms, intolerance to therapy, or malnutrition related to the condition. In these situations, a feeding tube  called jejunostomy tube can be placed in the small intestine.Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin.
Venting tubes placed into the stomach may reduce symptoms and hospitalizations for person with recurrent vomiting and dehydration. These tubes are available to vent trapped air from within the poorly contracting stomach.
Some people may require an IV (parenteral) feeding tube that goes directly into a vein in the chest. The stomach is completely removed in some rare cases.

Electrical Gastric Stimulation:

Gastric electrical stimulation is a surgically implanted device that provides electrical stimulation to stimulate stomach muscles to move food more efficiently. It has its effect on the nerves that control sensation within the stomach wall. This technique uses electrodes that are surgically or endoscopically attached to the stomach wall and when stimulated, trigger stomach contractions. The device seems to be most helpful for people with diabetic gastroparesis.

Gastric pacing:

Gastric pacing also involves a surgically implanted pacemaker, usually placed laparoscopically that stimulates the stomach muscles    

Maintaining Nutrition:

Treatment options for dehydration and malnutrition include:

  • Intravenous fluids to correct dehydration and maintain electrolytes.
  • Intravenous total parenteral nutrition (TPN) which  is a fluid containing glucose, amino acids, lipids, minerals, and vitamins to provide calories and nutrients.The fluid usually is delivered into a large vein via a catheter in the arm or upper chest.
  • Enteral nutrition which provides liquid food directly into the small intestine, bypassing the paralyzed stomach.

Enteral nutrition is preferred over TPN because long term use of TPN is associated with infections of the catheter and liver damage. when infection spread through the blood to the rest of the body, a serious condition called sepsis occurs.