Updated February 11, 2008

Treating Gastroparesis

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

It’s also important for a person to take in enough calories and nutrients to maintain his body weight. Meals should have a low fat and fiber content and be small in volume. Daily consumption may therefore be divided into six small meals taken throughout the day. Liquids and solid foods that have been pureed in a blender are encouraged. Some examples of recipes for liquid meals can be found in "Recipes for a Liquid Diet."

All people with gastroparesis are advised to monitor their blood glucose frequently. Intensive blood glucose control that keeps levels stable and as close to normal as possible appears to reduce the severity of gastroparesis symptoms. High blood glucose, on the other hand, can worsen the slow movement of food through the gastrointestinal tract. A continuous glucose monitoring system, which uses a sensor to measure glucose levels in fluid under the skin as often as every few minutes, can be a useful tool for tracking trends in glucose levels.

Checking blood glucose levels after meals is especially important to determine whether either food intake or the timing or size of insulin doses needs to be adjusted to maintain blood glucose within goal range. Some people who use rapid-acting insulin such as lispro (brand name Humalog), aspart (NovoLog), or glulisine (Apidra) administer their injection after they’ve finished eating a meal so they can better match the timing of food absorption. People who use an insulin pump can use the extended bolus or square-wave bolus features, which spread the delivery of an insulin dose over a selected period of time. A person’s health-care provider can assist with determining the percentage of insulin to be delayed and the duration of the bolus infusion. Oral diabetes medicines may also be considered by the health-care team for use alone or together with insulin.

Medical treatments
In addition to blood glucose control, certain drugs or other treatments can also help reduce the symptoms of gastroparesis. For a list of the drugs, see "Medicines to Treat Gastroparesis."

Total parenteral nutrition. People who do not improve with medicines and who cannot get the proper nutrition through eating are often hospitalized so they can benefit from intravenous fluids that provide calories, minerals, vitamins, and nutrients, a type of treatment known as total parenteral nutrition. A tube may be threaded through the person’s nose into the stomach to drain fluid and air.

Enteral nutrition. An alternative to total parenteral nutrition is enteral nutrition, in which the necessary medicines and nutrients are provided directly into the gastrointestinal tract via a tube placed into the stomach or small intestine. The tube can also be used to drain liquid and air from the gastrointestinal tract. Both total parenteral nutrition and enteral nutrition treatments may last for a long period of time, depending on when the stomach is able to handle solid food again.

Gastric electrical stimulation. When a person has not responded to drug treatment or other conservative treatments such as changing the amounts or types of food in the diet, gastric electrical stimulation may be tried. This technique uses mild electrical pulses produced by a gastric pacemaker to stimulate the nerves of the lower stomach. These pulses are transmitted by means of electrodes that are surgically placed in the wall of the lower stomach. The settings of the device can be adjusted with an external programming system based on individual circumstances, such as the number of times a person becomes nauseated and vomits. Gastric electrical stimulation can be temporarily stopped by the health-care provider if a person needs to undergo magnetic resonance imaging (MRI), radiation therapy, defibrillation, or other medical procedures. This therapy may be used in conjunction with specific medicines to decrease gastroparesis symptoms.

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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