Gastroparesis happens when nerves to the stomach are damaged
or stop working. The vagus nerve controls the movement of food
through the digestive tract. If the vagus nerve is damaged, the
muscles of the stomach and intestines do not work normally, and
the movement of food is slowed or stopped.
Diabetes can damage the vagus nerve if blood glucose levels
remain high over a long period of time. High blood glucose causes
chemical changes in nerves and damages the blood vessels that
carry oxygen and nutrients to the nerves.
Signs and Symptoms
These symptoms of Gastroparesis may be mild or severe, depending
on the person.
Signs and symptoms of gastroparesis include:
> vomiting of undigested food
> an early feeling of fullness when eating
> weight loss
> abdominal bloating
> erratic blood glucose levels
> lack of appetite
> gastroesophageal reflux
> spasms of the stomach wall
Complications of Gastroparesis
If food lingers too long in the stomach, it can cause problems
like bacterial overgrowth from the fermentation of food. Also,
the food can harden into solid masses called bezoars that may
cause nausea, vomiting, and obstruction in the stomach. Bezoars
can be dangerous if they block the passage of food into the small
Gastroparesis can make diabetes worse by adding to the difficulty
of controlling blood glucose. When food that has been delayed
in the stomach finally enters the small intestine and is absorbed,
blood glucose levels rise. Since gastroparesis makes stomach
emptying unpredictable, a person's blood glucose levels can be
erratic and difficult to control.
The diagnosis of gastroparesis is confirmed through one or
more of the following tests.
Barium x ray. After fasting for 12 hours, you will drink a thick
liquid called barium, which coats the inside of the stomach,
making it show up on the x ray. Normally, the stomach will be
empty of all food after 12 hours of fasting. If the x ray shows
food in the stomach, gastroparesis is likely. If the x ray shows
an empty stomach but the doctor still suspects that you have
delayed emptying, you may need to repeat the test another day.
On any one day, a person with gastroparesis may digest a meal
normally, giving a falsely normal test result. If you have diabetes,
your doctor may have special instructions about fasting.
Barium beefsteak meal. You will eat a meal that contains barium,
thus allowing the radiologist to watch your stomach as it digests
the meal. The amount of time it takes for the barium meal to
be digested and leave the stomach gives the doctor an idea of
how well the stomach is working. This test can help detect emptying
problems that do not show up on the liquid barium x ray. In fact,
people who have diabetes-related gastroparesis often digest fluid
normally, so the barium beefsteak meal can be more useful.
Radioisotope gastric-emptying scan. You will eat food that contains
a radioisotope, a slightly radioactive substance that will show
up on the scan. The dose of radiation from the radioisotope is
small and not dangerous. After eating, you will lie under a machine
that detects the radioisotope and shows an image of the food
in the stomach and how quickly it leaves the stomach. Gastroparesis
is diagnosed if more than half of the food remains in the stomach
after 2 hours.
Gastric manometry. This test measures electrical and muscular
activity in the stomach. The doctor passes a thin tube down the
throat into the stomach. The tube contains a wire that takes
measurements of the stomach's electrical and muscular activity
as it digests liquids and solid food. The measurements show how
the stomach is working and whether there is any delay in digestion.
Blood tests. The doctor may also order laboratory tests to check
blood counts and to measure chemical and electrolyte levels.
To rule out causes of gastroparesis other than diabetes, the
doctor may do an upper endoscopy or an ultrasound.
Treatment of Gastroparesis
The primary treatment goal for gastroparesis related to diabetes
is to regain control of blood glucose levels. Treatments include
insulin, oral medications, changes in what and when you eat,
and, in severe cases, feeding tubes and intravenous feeding.
It is important to note that in most cases
treatment does not cure gastroparesis—it is usually
a chronic condition. Treatment helps you manage the condition
so that you can be
and comfortable as possible.
If you have gastroparesis, your food is being absorbed more
slowly and at unpredictable times. To control blood glucose,
you may need to do the following:
> take insulin more often
> take your insulin after you eat instead of before
> check your blood glucose levels frequently after you eat and
administer insulin whenever necessary
Your doctor will give you specific instructions based on your
Several drugs are used to treat gastroparesis. Your doctor may
try different drugs or combinations of drugs to find the most
Metoclopramide (Reglan). This drug stimulates stomach muscle
contractions to help empty food. It also helps reduce nausea
and vomiting. Metoclopramide is taken 20 to 30 minutes before
meals and at bedtime. Side effects of this drug are fatigue,
sleepiness, and sometimes depression, anxiety, and problems with
Erythromycin. This antibiotic also improves stomach emptying.
It works by increasing the contractions that move food through
the stomach. Side effects are nausea, vomiting, and abdominal
Domperidone. The Food and Drug Administration is reviewing domperidone,
which has been used elsewhere in the world to treat gastroparesis.
It is a promotility agent like metoclopramide. Domperidone also
helps with nausea.
Other medications. Other medications may be used to treat symptoms
and problems related to gastroparesis. For example, an antiemetic
can help with nausea and vomiting. Antibiotics will clear up
a bacterial infection. If you have a bezoar, the doctor may use
an endoscope to inject medication that will dissolve it.
Meal and Food Changes
Changing your eating habits can help control gastroparesis. Your
doctor or dietitian will give you specific instructions, but
you may be asked to eat six small meals a day instead of three
large ones. If less food enters the stomach each time you eat,
it may not become overly full. Or the doctor or dietitian may
suggest that you try several liquid meals a day until your
blood glucose levels are stable and the gastroparesis is corrected.
Liquid meals provide all the nutrients found in solid foods,
but can pass through the stomach more easily and quickly.
The doctor may also recommend that you avoid
high-fat and high-fiber foods. Fat naturally slows digestion—a problem you do not
need if you have gastroparesis—and fiber is difficult to
digest. Some high-fiber foods like oranges and broccoli contain
material that cannot be digested. Avoid these foods because the
indigestible part will remain in the stomach too long and possibly
If other approaches do not work, you may need surgery to insert
a feeding tube. The tube, called a jejunostomy tube, is inserted
through the skin on your abdomen into the small intestine.
The feeding tube allows you to put nutrients directly into
the small intestine, bypassing the stomach altogether. You
will receive special liquid food to use with the tube. A jejunostomy
is particularly useful when gastroparesis prevents the nutrients
and medication necessary to regulate blood glucose levels from
reaching the bloodstream. By avoiding the source of the problem—the
stomach—and putting nutrients and medication directly
into the small intestine, you ensure that these products are
digested and delivered to your bloodstream quickly. A jejunostomy
tube can be temporary and is used only if necessary when gastroparesis
Parenteral nutrition refers to delivering nutrients directly
into the bloodstream, bypassing the digestive system. The doctor
places a thin tube called a catheter in a chest vein, leaving
an opening to it outside the skin. For feeding, you attach
a bag containing liquid nutrients or medication to the catheter.
The fluid enters your bloodstream through the vein. Your doctor
will tell you what type of liquid nutrition to use.
This approach is an alternative to the jejunostomy tube and
is usually a temporary method to get you through a difficult
spell of gastroparesis. Parenteral nutrition is used only when
gastroparesis is severe and is not helped by other methods.
A gastric neurostimulator has been developed to assist people
with gastroparesis. The battery-operated device is surgically
implanted and emits mild electrical pulses that help control
nausea and vomiting associated with gastroparesis. This option
is available to people whose nausea and vomiting do not improve
The use of botulinum toxin has been shown to improve stomach
emptying and the symptoms of gastroparesis by decreasing the
prolonged contractions of the muscle between the stomach and
the small intestine (pyloric sphincter). The toxin is injected
into the pyloric sphincter.
Latest Research on Gastroparesis
NIDDK's Division of Digestive Diseases and Nutrition supports
basic and clinical research into gastrointestinal motility
disorders, including gastroparesis. Among other areas, researchers
are studying whether experimental medications can relieve or
reduce symptoms of gastroparesis, such as bloating, abdominal
pain, nausea, and vomiting, or shorten the time needed by the
stomach to empty its contents following a standard meal.