Updated February 11, 2008

Treating Gastroparesis

by Kathryn Feigenbaum, R.N., M.S.N., C.D.E.

Although the term gastroparesis may be new to some, the symptoms of this ailment, in which the stomach’s ability to move food into the small intestine is impaired, can be all too familiar, as up to 50% of people with diabetes will develop gastroparesis. The slow stomach emptying characteristic of this condition can cause nausea, vomiting, a feeling of fullness after eating a small amount of food, bloating, discomfort in the upper abdomen, and a lack of appetite. These symptoms can also be accompanied by erratic blood glucose levels, requiring frequent blood glucose checks and injections of insulin.

Symptoms and complications
The most common cause of gastroparesis is damage to the nerve fibers that control the movements of the stomach, branches of a major nerve known as the vagus nerve. The exact cause of the nerve damage is not completely understood, but the most widely accepted theory is that insulin deficiency, high blood glucose levels, or both gradually damage the vagus nerve.

Symptoms associated with gastroparesis include heartburn, reflux of food and liquids into the esophagus, difficulty swallowing, hypoglycemia (low blood glucose) after a meal followed by high blood glucose, constipation alternating with diarrhea, and weight loss. Other consequences and complications include the erratic absorption of medicines taken by mouth, foul breath, dehydration, electrolyte imbalance (electrolytes include salts such as sodium and potassium), and potentially even coma and death.

Gastroparesis can be diagnosed by special studies that evaluate how well the stomach and small intestine are digesting food. The common tests used for diagnosis are listed in "Diagnostic Tests for Gastroparesis."

At times, the symptoms of gastroparesis may improve or even disappear. However, the actual delay in stomach emptying time does not seem to correlate very well with the symptoms a person experiences. Additionally, the severity of nerve damage does not match the intensity of the symptoms.

Some people with gastroparesis develop bacterial infections in their stomach or small intestine, and others form a mass of undigested food in the stomach called a bezoar. This retained undigested material can worsen a person’s nausea and vomiting and can sometimes even develop into a complete blockage between the stomach and the small intestine.

Treatments for bezoars may include taking papaya juice or an enzyme known as cellulase orally or via injection to aid digestion. More serious bezoars may require the placement of a tube through the nose into the stomach so that the stomach can be flushed with Coca-Cola or a medicine called acetylcysteine, both of which can help dissolve the mass. Sometimes the undigested material can be broken up and taken out through the mouth using special equipment or through an incision into the stomach. Following any type of bezoar treatment, people must typically stick to a liquid diet for several months to help minimize the accumulation of undigested material in the stomach.

Managing blood glucose and nutrition
Having to follow a liquid diet for a prolonged period can be difficult for some people. However, individual preferences and tastes can be incorporated into the diet to make meals more palatable. Special consideration is needed to make sure that required nutrients, vitamins, minerals, and electrolytes are included in the diet. For example, people with gastroparesis are sometimes deficient in vitamins and minerals such as vitamin B12, vitamin D, and iron, and may therefore need supplements containing these micronutrients. Stomach irritants such as nicotine and caffeine should be avoided.

Also in this article:
Recipes for a Liquid Diet

Kathryn Feigenbaum is a Clinical Nurse Specialist in Endocrinology at the National Institutes of Health in Bethesda, Maryland. This article was prepared as part of her official duties as a government employee.

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