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Gastroparesis (GP) is a chronic motility disorder of the stomach. GP often responds to multiple treatment options even though a 100% cure is unlikely. You have been referred to our specialty clinic for recommendations on guiding you to a personalized treatment regimen that best fits you.

In GP, the stomach has difficulty, or the inability, to empty its contents into the small intestine. The result is that ingested food, liquid, and swallowed air remains in the stomach instead of passing through. A range of symptoms are then experienced by the patient. Classically, patients experience nausea, vomiting, bloating, reflux and abdominal pain. These symptoms are directly related to the immobility of the stomach. Our goal is to you improve your symptoms.

Causes

In our clinic, most GP patients acquired the disease for an unknown reason (idiopathic). Other causes include from diabetic neuropathy, and as a result of a surgical procedure intended for another diagnosis. Some possible idiopathic sources thought to cause GP are viruses, neurological disorders, autoimmune diseases, hypo and hyperthyroidism, mitochondrial diseases and eating disorders.

Diagnosis

Once symptoms of GP are identified, objective testing should be done to confirm the diagnosis. A gastric emptying study (GES) is the gold standard. It involves the patient eating a meal, usually scrambled eggs, labeled with trace amount of radioactive material. Scans are then taken of the patient at different time intervals, up to 4 hours, to watch the progression of the meal through the stomach. Based on the remaining amount of stomach contents at the end of each interval will diagnose GP.

Treatment

Narcotics DO NOT successfully treat the symptoms.

Regardless of the cause, the treatments are the same. There is no cure for gastroparesis, but there are treatments available for symptomatic relief that vary in their effectiveness.

Most people with GP require a combination of treatments.

 1.    Diet

***MAIN GOALS – low fat, low fiber, small frequent meals***

    • General diet guidelines
    • Eat frequently – 5 small meals a day, and avoid large meals.
    • Decrease high fatty meals
    • However, fats in liquids, such as milkshakes, can be a great source of needed daily calories that are well tolerated because they are in liquid form and pass easily through the stomach.
    • Start with the solid part of the meal, and follow with the liquids. This can aid to flush food through the stomach.
    • Chew foods to a puree. Especially with meats.
    • Using digestive enzymes can help break down proteins, fats, and carbohydrates. Enzymes such as sorbitol, lactose, sucrose, and fructose.
    • Remain upright after eating for at least an hour. Incorporate walks after eating.
    • Continually check your weight. This can be the first sign that you are not taking adequate nutrition.
    • Keep hydrated, even when symptoms (i.e. vomiting) are at the worst. Take small sips of liquids. Avoid using straws. Dehydration can make the symptoms worse.
  • Diet modification
    • Avoiding certain foods such as fatty foods. It is known that fats slow stomach emptying, even in the general population.
    • Avoiding spices.
    • Avoiding certain meats – especially red meat.
    • Avoid high fiber content foods.
    • Avoid certain fruits and vegetables.
  • Recommended food
    • Soups
    • Crackers
    • Hard candy
    • Starches such as pasta, rice, and potatoes. These tend to provoke stomach emptying.
    • Meats such as baked chicken and fish.
  • You may want to seek out a nutritionist to tailor a diet to you.

*REMEMBER – the goal is to help your stomach empty.

    • Fats and fiber empty the slowest, while large meals will take longer to empty.
    • Therefore, low fat, low fiber and small frequent meals are the mainstay.

2.    Medication

  • Prokinetics (increase motility) - Unfortunately, prokinetic options have been dramatically reduced over recent years due to safety concerns making alternative therapies even more important. However, domperidone is still in a reasonable option.
    • Domperidone
      • In the setting of GP, it is used as a prokinetic (increases stomach motility). In fact, trade names for the drug stem from its action, i.e. Motilium.
      • It has also been shown to have some antiemetic (anti-vomiting/nausea) effects.
      • Unfortunately, domperidone is not approved by the FDA for use in this country because of its unknown side effect panel. The main controversy is because it is secreted in breast milk, and the effects are unknown.
      • The medication does prove to improve symptoms in some GP patients, and it may be advisable for the patient to take on the responsibility of obtaining the medication on their own and using it at their own risk if the benefit outweighs the poorly tolerated symptoms of GP.
      • Anti-emetics (help to prevent nausea and/or vomiting)- such as zofran or phenergan.

3.    Natural remedies

  • Dai-kenchu-to
    • This is an herbal medicine containing Dai-kenchu-to extract powder and malt sugar produced in Japan.
    • It has been shown to increase intestinal motility in patients that have had a cessation of intestinal motility following surgery.
    • This can be prepared by an acupuncturist familiar with Chinese herbal formulas.
      • Inner Gate Acupuncture and Herbal Clinic is familiar with this formulation.

4.      Surgery  - your surgeon will discuss which procedure is right for you. Surgery may become an option as these prior methods don't help improve symptoms.

  • Pyloroplasty
    • This procedure is done in the operating room under general anesthesia. It is done with a minimally invasive surgery technique. The surgery permanently opens the valve at the end of the stomach that allows contents to pass easier into the small intestine. In GP, this valve functions poorly and remains closed impending stomach emptying resulting in the symptoms.
       
  • Gastric Nerve Stimulator (GNS) - Product name is Enterra
    • This procedure is done in the operating room under general anesthesia. Electrodes are implanted at certain locations in the stomach wall that carry an impulse from a transducer placed in the abdominal wall. The impulses act to increase the stomach's motility. The transducer is accessed transcutaneously (across the skin without the use of needles) to monitor its strength of contractions and for maintenance.
       
  • Gastrostomy tube (G-tube)
    • This is a procedure that can be done in the operating room or in the endoscopy suite. A tube is placed into your stomach, and comes out of your abdomen, to act as a vent for air to escape that would normally cause bloating, distention, and nausea.
       
  • Jejunostomy tube (J-tube)
    • This is a tube that placed in the operating room while you are under general anesthesia. The tube enters your intestine through your abdominal wall. It aids to provide nutritional supplements to meet recommended goals.
       
  • Gastrectomy
    • This procedure is used as a last resort. This is done in the operating room under general anesthesia, and the stomach is removed. The small intestine takes the place of the stomach, bypassing the problem organ.

For additional references:

www.g-pact.org

www.digestivedistress.com