Gastroparesis
A healthy stomach does not merely store food: it grinds it down and pushes it onward into the duodenum in measured portions.
On this page
Medicines commonly prescribed for Gastroparesis
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: INJECTABLE, 10 mg metoclopramide/2 mlActive substance: metoclopramideManufacturer: Sanofi Aventis S.A.Prescription requiredDosage form: TABLET, 10 mgActive substance: domperidoneManufacturer: Towa Pharmaceutical S.A.Prescription requiredDosage form: INJECTABLE, 5 mg/mlActive substance: metoclopramideManufacturer: Laboratorios Basi Industria Farmaceutica S.A.Prescription required
A healthy stomach does not merely store food: it grinds it down and pushes it onward into the duodenum in measured portions. It works like a mill with a metering device — the wall contracts in waves, the pylorus opens just enough to let the ground-up mass through, and within a few hours the stomach is empty. In gastroparesis the mill turns sluggishly: there is no blockage, the way out is clear, and yet the contents sit there. Hence the complaints — a feeling of a stone after two spoonfuls, nausea, vomiting up what was eaten the day before. The diagnosis is made less often than the problem occurs, because the symptoms are easily taken for a "nervous stomach" or a flare of gastritis.
What goes on inside the stomach
The rhythm of the stomach's contractions is set by pacemaker cells in the wall of the organ and by the vagus nerve, which runs down from the brain. If the nerve is damaged and the pacemaker cells have dwindled, coordination is lost: the upper stomach relaxes poorly to take food in, the waves of contraction weaken, and the pylorus, by contrast, goes into spasm. Solid food stays inside for hours longer than it should.
It is worth understanding how this differs from a mechanical obstruction. With a tumour, a scar from an old ulcer or pressure from outside the pattern of symptoms is almost identical, but there a physical barrier exists and the approach is entirely different. That is why gastroparesis is never diagnosed on symptoms alone: the first step is to establish that the exit from the stomach is clear.
How it feels
Every complaint is tied to eating and builds up towards evening, once several undigested meals have accumulated over the day.
- Fullness after a few spoonfuls, with no way of finishing your usual plate.
- Nausea that drags on for hours and depends little on what exactly you ate.
- Vomiting, sometimes of food eaten many hours or even a day earlier — an unmistakable sign of stasis.
- Bloating and distension in the upper abdomen, at times visible to the eye.
- Heartburn and belching: retained contents press upward and reflux into the gullet.
- A dull ache high in the abdomen, seldom severe but wearing because it never lets up.
- Weight loss, dehydration and vitamin deficiencies if this goes on for months.
People with diabetes have one further feature that is easy to miss: blood sugar starts behaving unpredictably. Insulin goes in before the meal, but the meal reaches the intestine late, so glucose first drops and then shoots up. An unexplained see-saw in someone who has changed nothing about their treatment is a reason to think about the stomach.
When it cannot wait
Call an ambulance if any one of the following appears:
- sudden severe abdominal pain;
- vomiting blood or dark material resembling coffee grounds;
- vomit that smells of bowel contents, which points to obstruction;
- you have been unable to keep even water down for more than a day, your mouth is dry, you are barely passing urine and you feel dizzy on standing.
In Spain, Italy, Portugal, Poland and Ukraine an ambulance is called on the single European number 112. Everything else — persistent nausea, repeated vomiting, weight loss, a lump you can feel in the abdomen — does not need an ambulance, but it does need a doctor within days rather than in six months' time.
Why the stomach slows down
A cause cannot always be named: a sizeable share of cases is never explained and is called idiopathic. Some of those begin abruptly, after an ordinary bout of gastroenteritis, and gradually settle over time.
Among the known causes, diabetes comes first. Years of high blood sugar damage the small nerves, including those that govern the stomach, by the same mechanism that harms the feet and the eyes. The second common cause is surgery in which the vagus nerve was injured: operations on the oesophagus, on the stomach and sometimes on the lung or the heart.
The medicine list deserves a separate look, because everything there is reversible. Opioid painkillers slow the stomach, as do drugs with anticholinergic effects, some antidepressants, certain blood pressure treatments, parkinson's medication, and also the modern drugs for weight loss and diabetes from the glucagon-like peptide receptor agonist group, for which delaying gastric emptying is actually part of how they work. If the symptoms started shortly after a new prescription, that is the first thing to raise with your doctor.
Less often, systemic disease lies behind it: scleroderma and other connective tissue disorders, parkinson's disease, multiple sclerosis, amyloidosis. A shortage of thyroid hormone also slows digestion, and it is fully correctable. There is a rare but important possibility as well: a similar picture is occasionally the first sign of a tumour, either in the stomach or pancreas themselves or at a distance, when the tumour triggers an autoimmune attack on the nerve networks of the gut. Because of scenarios like that, gastroparesis of sudden onset in someone with no diabetes and no previous surgery is investigated thoroughly.
How it is confirmed
Everything else is ruled out first. Blood tests are taken: glucose and glycated haemoglobin, thyroid hormones, inflammatory markers, iron and electrolytes. Then the exit from the stomach is checked, which means endoscopy, sometimes supplemented by an abdominal ultrasound scan or a CT scan.
If there is no obstruction, the rate of emptying is measured. The main method is scintigraphy: you eat a standard meal containing a safe marker and the scanner counts over several hours how much of it is still in the stomach. There is also a breath-test version and a capsule that travels through the digestive tract transmitting data. Preparation matters: drugs affecting motility are stopped beforehand, and in diabetes the blood sugar is brought to normal, since a high glucose level slows the stomach in its own right and spoils the result.
Food that goes through more easily
Eating is not a supporting measure in gastroparesis but the foundation of treatment, and it achieves more than most tablets.
- Have four to six small meals a day instead of three ordinary ones: the stomach shifts a small volume far more willingly.
- Cut the fat in solid food, as fat delays emptying more than anything else. In liquid form fat is tolerated much better, which helps when calories are needed.
- Reduce coarse insoluble fibre: skins, bran, stringy vegetables, pulses, nuts. This is not about giving up vegetables but about cooking and puréeing them.
- On bad days switch to purées, soups and drinks: liquids leave the stomach even when solids stand still.
- Chew slowly, sip rather than gulp, and stay upright for at least an hour after eating — a walk is better still.
- Drop fizzy drinks, spirits and smoking: all of them add both bloating and stasis.
Fibre deserves a note of its own. In a stagnant stomach fibres sometimes mat together into a dense lump, a bezoar, which then obstructs the passage of food itself and occasionally has to be removed endoscopically. So the advice to "eat more fibre", sound for almost everyone, is actively unhelpful here. If weight is falling, ask for a referral to a dietitian: choosing nutritional supplements and working out whether you are getting enough protein, iron and vitamins is hard to do alone.
Medicines and procedures
The drug options are more modest than one would wish, and almost all of them come with limits on how long they can be used.
- Prokinetics speed food along. Metoclopramide is prescribed in short courses, because prolonged use can bring on persistent involuntary movements. Domperidone acts less on the brain but calls for attention to heart rhythm and is likewise not meant for years on end. One of the macrolide antibiotics is also used at low doses, though its effect fades with time.
- Anti-sickness drugs ease nausea but do not speed the stomach up. They are chosen by tolerance, again with heart rhythm in mind.
- Pain control is a delicate area. Opioids look like the logical choice, yet they slow the stomach still further and trap the person in a vicious circle. Other routes are used instead, among them low doses of drugs that alter how pain is perceived.
- In diabetes the blood sugar comes first: glycaemic control and gastric emptying influence one another, and neither can be sorted out without the other.
When that is not enough, procedures are discussed. Botulinum toxin injection into the pylorus is performed, but large trials have not borne out its usefulness and the method remains contested. Cutting the pyloric muscle endoscopically helps a proportion of patients, particularly those with marked pyloric spasm. There is also an implantable gastric stimulator, which mainly reduces nausea and vomiting. In the most severe cases a tube is placed into the small bowel, bypassing the stomach, so that the person neither loses weight nor becomes dehydrated.
Online consultation
Gastroparesis is precisely the kind of diagnosis where a remote appointment achieves a great deal. The doctor will work through how the symptoms relate to meals and at what time of day they bite hardest, go over your list of medicines and pick out those that could have slowed the stomach, and explain which investigations come first and why obstruction has to be excluded before anything else. Diet is a job in itself: walking through an ordinary day with you, spotting where the food is too fatty or too coarse, drawing up a workable plan for the week and deciding whether nutritional supplements are needed. Online is also a convenient way to run the treatment: watching tolerance to prokinetics, raising the question of course length in good time, going through glucose traces and insulin timing in diabetes, making sense of a scintigraphy report and preparing questions for the gastroenterologist. The format fails in one situation only: when there is blood in the vomit, when the abdomen suddenly seizes up, or when you have gone two days without keeping fluids down. Then you need to be seen in person, and quickly.
This material is for information only and does not replace medical advice.
Consult with a doctor about Gastroparesis
Discuss your symptoms and possible next steps with a doctor online.
Online doctors for Gastroparesis
Discuss your symptoms and possible next steps for Gastroparesis with a doctor online.
