Understanding gastroparesis

August 23, 2024

Providence Digestive Health Institute

[5 MIN READ]

Gastroparesis refers to the delayed emptying of the stomach because either the muscles or nerves (or both) aren’t working right.
An important way to decrease your gastroparesis symptoms is through diet — eating six or seven low-fat, low-fiber meals a day.
There is no cure for gastroparesis, but you can often manage your symptoms and maintain a good quality of life through careful management of your diet (monitoring what and how often you eat).

Understanding gastroparesis: Signs, symptoms and treatment

Among the long list of gastrointestinal conditions, gastroparesis is one of the most challenging. By necessity, when you are living with gastroparesis, you become a kind of active researcher, taking copious notes on what does or doesn’t work to help you be more comfortable. Lifestyle changes may help you control some symptoms, but if those don’t help, your doctor can create a treatment plan.

What is gastroparesis?

Gastroparesis interferes with the muscle and/or nerve activity that moves food through your stomach and into your small intestine. “It’s delayed stomach emptying because the muscles and/or nerves aren’t working correctly. There are different degrees of it — some people might have only mild symptoms, while others are more severe,” says Jasmine Zia, M.D., a gastroenterologist with Swedish Gastroenterology in Seattle, Washington.

Researchers don’t know all the causes of gastroparesis, but they do know that it’s common in people with diabetes — about one-third of gastroparesis cases are people with diabetes. It can also sometimes occur after certain surgical procedures. But up to half of gastroparesis cases are idiopathic, which means the exact cause is unknown.

Gastroparesis symptoms

The most common symptoms of gastroparesis include:

The feeling of fullness, also known as early satiety
Abdominal bloating and pain
Indigestion
Loss of appetite
Nausea and vomiting
Weight loss and malnutrition

When food stays in your stomach, you feel full. That sensation can persist for a long time and turn into a stomachache. You may want to throw up, or you may develop heartburn or acid reflux.

“It’s like a domino effect,” says Dr. Zia. “Because the food in your stomach moves slowly out into the small intestine, it ends up moving up and can cause heartburn, or acid reflux. If you have slow emptying of your stomach, you’re also at increased risk of having slow emptying anywhere else along the gastrointestinal tract (e.g., small or large intestines), leading to bloating or constipation. Everything in the body affects everything else.”

Diagnosing gastroparesis

The gold standard for diagnosis of gastroparesis is a gastric emptying study. During this test, your doctor will ask you to eat a light meal (such as eggs and toast) that contains a small amount of radioactive material. A technician will place a scanner over your abdomen to monitor how fast the food is leaving your stomach. If the food is moving into your small intestine at a slower rate than normal, your doctor will be able to make a gastroparesis diagnosis.

Treatment options for gastroparesis

“When we diagnose someone with gastroparesis, we look at your medications to see if that could be the cause,” says Dr. Zia. “If there’s a culprit medication and you are able to stop using it, then we will do that. If you have diabetes and are able to better control your sugar, you can also improve your gastroparesis. If neither of those issues is the problem, we will work on dietary changes and medications next to help relieve your symptoms of gastroparesis.”

“I always say that diet, diet and diet are the No. 1, No. 2 and No. 3 ways to treat gastroparesis,” she says. “Almost all of my patients work with a dietitian so they can develop a low-fat, low-fiber plan that will minimize their symptoms. The best plan for gastroparesis is to eat six to seven small meals each day.”

“I tell my patients that gastroparesis is kind of like a stroke,” adds Dr. Zia. “You might get a little bit of function back either with time or medications, but that nerve damage can sometimes be permanent.”

When all other options for treatment have been exhausted, there are three different types of experimental surgery that may help:

Gastric pacemaker placement: The device is surgically implanted under the skin and connected to two electrodes placed on the stomach wall to help stimulate the stomach nerves. Studies have shown it works best for patients with diabetes.
Gastric drainage surgery: This surgery cuts the sphincter between the stomach and small intestine to help food drain out of the stomach faster.
Feeding tube placement into the small intestine: The tube bypasses the stomach. This last-resort procedure is only used when gastroparesis is severe and does not respond to dietary changes, medications and the two other surgeries listed above (gastric pacemaker placement or gastric drainage surgery).

“It’s important to know that these surgeries will likely not make you completely symptom-free,” says Dr. Zia. “The gastric pacemaker and gastric drainage surgery are still experimental, but we offer them because they have been shown to be helpful in some types of patients.”

Managing life with gastroparesis

Gastroparesis is a chronic disorder that can have many different levels of severity, and symptoms will come and go and/or wax and wane in intensity.

“A lot of living with gastroparesis involves educating the people you love,” says Dr. Zia. “You will need to explain to them that food sits in your stomach much longer than with other people. Because of that, you need to plan your life around eating small meals and avoiding certain types of foods.”

If you think you might have gastroparesis, you can find the help you need at the Providence Digestive Health Institute.

Contributing caregiver

Jasmine Zia, M.D., is a gastroenterologist with Swedish Gastroenterology in Seattle, Washington.

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