Updated May 22, 2006

Gastroparesis

In the United States, there are a few drugs either available or in development to treat gastroparesis. The antibiotic erythromycin increases the muscle contractions that push food through the stomach and is sometimes prescribed to treat gastroparesis. Metoclopramide (brand name Reglan) is a “prokinetic” drug, which means it stimulates stomach muscle contractions; it also reduces nausea and vomiting. Unfortunately, it can have troubling side effects such as depression, anxiety, and movement disorders. Domperidone, a prokinetic drug like metoclopramide, helps with stomach muscle contraction and eases nausea. It has been used elsewhere in the world and is currently under review by the U.S. Food and Drug Administration.

Dietary changes may also help alleviate symptoms of gastroparesis. In some cases, people are instructed to eat five or six small meals a day rather than fewer large ones to prevent the stomach from becoming too full. Sometimes a doctor or dietitian prescribes special liquid meals until the gastroparesis resolves, because liquid meals pass through the stomach more easily. Doctors often recommend avoiding foods high in fat or high in fiber because fat and fiber are difficult to digest.

For cases of gastroparesis that don’t respond adequately to lifestyle changes and medication, some more invasive procedures might help:

• A feeding tube, called a jejunostomy tube, may be inserted through an incision in the abdomen and into the small intestine. The feeding tube allows nutrients to reach the small intestine without going through the stomach. The feeding tube is temporary for most people and is removed once the gastroparesis becomes less severe.
• Parenteral nutrition involves delivering nutrients directly into the bloodstream through a catheter inserted in a chest vein. It is usually a temporary measure used during very severe bouts of gastroparesis.
• A new device called a gastric neurostimulator is sometimes used to improve the symptoms of gastroparesis in people who don’t respond adequately to medication. It is surgically implanted and emits electrical pulses that help control nausea and vomiting.
• Recent studies also show that botulinum toxin (Botox) injections to the pylorus muscle, which regulates food passage from the stomach, can temporarily paralyze the muscle, allowing food to move from the stomach into the small intestine more easily.

Diabetic gastroparesis can be a very difficult condition to treat. However, by making lifestyle changes and taking steps to get medical help, many people eventually find relief from its symptoms.

This article was written by Diane Fennell, an Assistant Editor at Diabetes Self-Management.

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