Gastroparesis

What treatment is available for gastroparesis?

Healthcare providers can’t directly fix the damage that causes gastroparesis, but they can offer treatment to stimulate muscle contractions in your stomach and encourage it to empty. Medications are the first-line treatment, with surgery reserved for those who don’t respond to medications or can’t take them. All of the treatments have potential side effects, and no one treatment works for everyone.

The goals of treatment are to:

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• Stimulate your stomach muscles and/or allow your stomach to empty.
• Make sure your body has the nutrition and hydration it needs.
• Manage symptoms and side effects of the condition.
• Manage the cause, if possible, to prevent it from getting worse.

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Your treatment plan may include:

• Medications.
• Nutrition/hydration therapy.
• Surgery.
• Specific treatments for the condition causing your gastroparesis.

Medications

Prokinetics, medications that stimulate gastrointestinal motility, are the first-line treatment for gastroparesis. Prokinetics include:

• Metoclopramide. This is the only FDA-approved medication to treat gastroparesis. It stimulates muscle contractions in your stomach and can also help relieve nausea. However, it comes with a black-label warning because it can cause neurological side effects, including tremors and muscle twitching.
• Motolin agonists. Motolin agonists are an alternative type of prokinetic drug that your provider might suggest. They include erythromycin and azithromycin. They’re normally used as antibiotics, but healthcare providers do prescribe them for off-label treatment of gastroparesis.
• Serotonin agonists. Tegaserod and prucalopride are two serotonin agonists that are normally prescribed to stimulate your bowels to improve constipation. They haven’t been fully evaluated for treating gastroparesis, but some healthcare providers prescribe them for that use.
• Dopamine antagonists. A drug called domperidone can improve gastric motility and nausea by blocking a neurotransmitter called dopamine. It’s not normally available in the U.S., but U.S. healthcare providers can apply for expanded access to the drug to prescribe it for gastroparesis.

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Additional medications may include:

• Antiemetics to control nausea and vomiting.
• Proton pump inhibitors to treat acid reflux.
• Pain relievers for significant stomach pain.
• Diabetes medications to manage blood sugar.

Nutrition

You might need to change your diet to accommodate your condition — for example, eat less fiber and less fat to make digestion easier. You might also need more specific nutritional therapy to replace missing nutrients. Your provider might prescribe dietary supplements, or even temporary tube feeding or IV feeding. Some people may need IV fluids to rehydrate and correct electrolyte imbalances.

Surgery

Surgery is the last resort in gastroparesis treatment. If all other treatments fail, you might need surgery to modify your stomach to help food pass through it. Procedures to modify your stomach include:

• Pyloroplasty. Pyloroplasty modifies your pylorus, the muscular valve at the bottom of your stomach that lets food empty out of it. Most pyloroplasties involve cutting into the pylorus muscle to relax and expand the opening. The most recent variation, called the G-POEM, is an endoscopic surgical procedure. That means that instead of cutting into your abdomen to access your stomach, a surgeon operates through an endoscope, a long tube passed through your mouth into your stomach. G-POEM stands for “gastric peroral endoscopic myotomy.” Translated, that means “in-the-stomach, through-the-mouth, by-endoscope muscle incision.”
• Gastric bypass. Some people may need to bypass the lower portion of their stomach completely, either because it’s no longer functional or because this procedure is more likely to succeed for them. The procedure involves a partial gastrectomy — removing or closing off part of your stomach — and creating a new outlet from your stomach to your small intestine (gastrojejunostomy). Gastric bypass is commonly offered as a weight loss surgery, especially for people with Type 2 diabetes related to obesity, and it can have dramatic effects on both conditions. Your provider might recommend it for severe diabetes-related gastroparesis.

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