Conventional Medical Treatments for Gastroparesis

What is gastroparesis?

Gastroparesis, also known as gastric stasis or delayed gastric emptying, is a condition in which the stomach takes longer than normal to empty its contents. Under normal circumstances, strong muscle contractions move food through the digestive tract. With gastroparesis, damaged nerves and muscles cause these contractions to slow and weaken. Large masses of food can form in the stomach, which can cause digestive symptoms and even prevent food from entering the small intestine.

Conventional medical treatments for gastroparesis

Conventional medical treatments for gastroparesis aim to stimulate the stomach muscles, reduce symptoms such as nausea and vomiting, and ensure that adequate nutrition is received. Treatments include dietary changes, medications, and certain medical procedures.

Dietary changes

One of the best ways to treat gastroparesis is to make simple dietary changes. These changes include the following:

• Eating five to six small meals per day instead of three large meals
• Drinking plenty of liquids, such as water, low-fat broths and soups, and sports drinks
• Eating cooked fruits and vegetables instead of raw fruits and vegetables
• Avoiding high-fat or high-fiber foods, which slow down digestion
• Going for a walk after eating and avoiding lying down for at least two hours after eating

Medications

The medications metoclopramide and erythromycin can be used to stimulate the stomach muscles to improve gastric emptying. The medication domperidone both stimulates gastric emptying and works as an antiemetic. Other antiemetics, such as ondansetron, prochlorperazine, and promethazine, do not affect gastric emptying, but may help control nausea and vomiting. Pain medications may also be used to relieve stomach pain.

Another medication that may be used is onabotulinumtoxinA, a form of the botulinum toxin. OnabotulinumtoxinA can be injected into the valve between the stomach and small intestine. This relaxes the valve and helps it stay open longer so that the stomach can empty more easily.

Surgical treatments

Several surgical treatments are available to treat gastroparesis, including gastric electrical stimulation, endoscopic procedures, and venting gastrostomy.

• Gastric electrical stimulation
  During a gastric electrical stimulation procedure, a gastric stimulator, often referred to as a gastric pacemaker, is placed into the abdomen. This device connects to the stomach and delivers electrical stimulation to help control vomiting and reduce nausea. It is currently FDA approved under the Humanitarian Device Exemption. This allows devices to be marketed without requiring evidence of effectiveness.
• Endoscopic procedures
  During an endoscopic procedure, a thin tube is inserted through the mouth, down the esophagus, and into the stomach. An incision may be made in the valve that empties the stomach, or a small tube may be inserted in order to keep the connection between the stomach and small intestine open.
• Venting gastrostomy
  During a venting gastrostomy, a physician creates an opening in the stomach and places a tube in the opening. This allows the stomach contents to flow out through the tube which reduces pressure in the stomach.

Tube feeding

If gastroparesis prevents an individual from getting enough nutrients or calories, tube feeding may be necessary. Tube feeding can be delivered via a nasogastric tube, a jejunostomy tube, or intravenously.

• Nasogastric tube
  A nasogastric tube is placed into the nose, through the esophagus and stomach, and into the small intestine. Special liquid food goes through the tube and directly into the small intestine.
• Jejunostomy tube
  A jejunostomy tube is surgically placed through the abdomen and into the small intestine. This allows nutrients to enter the bloodstream more quickly than a nasogastric tube.
• Intravenous (IV) nutrition
  Also known as parenteral nutrition, nutrients can be sent straight into the bloodstream through a catheter placed in a large vein in the chest.