Gastroparesis

Diagnosis

Several tests are used to diagnose gastroparesis and rule out other digestive conditions that may cause similar symptoms. Your healthcare provider may recommend one or more of the following tests:

Gastric emptying tests
These tests measure how quickly food leaves your stomach.

• Scintigraphy
  This is the primary test for diagnosing gastroparesis. You’ll eat a light meal, such as eggs and toast, that contains a small amount of radioactive material. A scanner tracks the movement of the food through your stomach to see how quickly it empties.
  The test takes about four hours. You may need to stop taking medicines that can slow stomach emptying before the test—ask your healthcare provider for specific instructions.

• Breath tests
  During this test, you consume a food or drink containing a special substance that your body absorbs. Over several hours, your healthcare team collects breath samples to measure how much of the substance appears in your breath. These measurements help determine how fast your stomach empties.

Upper gastrointestinal (GI) endoscopy
This procedure uses a long, flexible tube with a camera to examine your esophagus, stomach, and the start of your small intestine (duodenum). It helps identify other conditions with similar symptoms, such as peptic ulcer disease or pyloric stenosis.

Ultrasound
Ultrasound uses sound waves to create images of organs inside the body. It helps rule out other possible causes of your symptoms, such as gallbladder or kidney problems.

Treatment

Treatment for gastroparesis focuses on managing symptoms, improving stomach function, and addressing any underlying causes—such as diabetes. If diabetes is responsible, managing blood sugar levels is a key part of treatment.

Changes to your diet
Adjusting your eating habits can help relieve symptoms and improve nutrition. A registered dietitian can help you create a diet plan suited to your needs.

A dietitian might suggest you:

• Eat smaller meals more often

• Chew food thoroughly

• Choose well-cooked fruits and vegetables instead of raw ones

• Avoid high-fiber produce such as oranges and broccoli that can form a hard mass (bezoar) in the stomach

• Choose mostly low-fat foods, or small servings of fat if tolerated

• Eat soups or pureed foods if liquids are easier to handle

• Drink 1 to 1.5 liters (34 to 51 ounces) of water daily

• Take gentle walks after meals

• Avoid carbonated drinks, alcohol, and smoking

• Stay upright for at least two hours after eating

• Take a daily multivitamin

• Separate eating and drinking by about an hour

Medications
Several types of medicines can help with gastroparesis:

• Medicines that help stomach muscles work

  • Metoclopramide (Reglan) is the only FDA-approved medication for gastroparesis. It’s now available as a nasal spray (Gimoti), which may cause fewer side effects than the pill form.

  • Erythromycin may also help but can become less effective over time and may cause diarrhea.

  • Domperidone can ease symptoms but is only available in the U.S. through a special FDA approval process.

• Medicines to control nausea and vomiting
  These include diphenhydramine (Benadryl), ondansetron, and prochlorperazine (Compro), which may be used if symptoms persist.

Surgical treatment
In severe cases where eating or drinking is difficult, your healthcare provider may recommend feeding or venting tubes.

• A jejunostomy tube is placed directly into the small intestine to deliver nutrition.

• A gastric venting tube helps release pressure from the stomach.

• In rare cases, an intravenous (IV) feeding tube may be needed for nutrition through a vein.

Feeding tubes are typically short-term solutions for severe gastroparesis or when blood sugar cannot be controlled by other means.

Treatments under study
Ongoing research is exploring new medications and minimally invasive procedures for gastroparesis.

• Relamorelin, an investigational drug, has shown promise in speeding up stomach emptying and reducing vomiting in early studies, though it is not yet FDA approved.

• Endoscopic pyloromyotomy (G-POEM) involves using an endoscope to cut the muscle between the stomach and small intestine (the pylorus) to help food pass more easily. Early results are promising, but more research is needed.

Gastric electrical stimulation
This surgical treatment uses a device that delivers mild electrical pulses to the stomach muscles to improve movement. It may be most effective for people with diabetic gastroparesis who do not respond to diet or medication. The FDA allows limited use of this device, and further studies are ongoing to evaluate its long-term benefits.

With the right combination of lifestyle changes, medical treatment, and ongoing care, many people with gastroparesis can manage their symptoms and maintain a better quality of life.