What are the treatments for gastroparesis?

Medications: Several medications are used to treat gastroparesis. Gastroparesis usually is treated with medications that stimulate contractions of the stomach muscles. The goal of treatment is to stimulate stomach contractions so that food is properly ground in the stomach and emptied into the intestine so that digestion can occur. There are two important guidelines in treating gastroparesis with medications. First, the drugs must be given at the right times, and second, the drugs must get into the blood stream to be effective. At the present time there are few medications available or are approved to treat gastroparesis and their use can be limited by undesirable side effects and limited effectiveness. The medications available include Metoclopramide, Erythromycin, Cisapride, Domperidone, and Tegaserod.

Dietary modifications: Changing eating habits can also help control gastroparesis. Sometimes, eating six smaller meals a day is more effective than eating three larger ones. Some physicians recommend several liquid meals a day until blood glucose levels are stable and gastroparesis is stable. Your physician may also recommend avoiding fatty and high-fiber foods, as these can slow digestion and be difficult to digest. It is important to consult your physician or dietitian for the best eating plan for your condition.

Surgery: Occasionally, when other approaches fail, it is necessary to perform a surgical procedure called jejunostomy, in which a feeding tube is inserted through the skin on the abdomen into the small intestine. This tube then allows nutrients to be put directly into the small intestine, bypassing the stomach. This is used only when gastroparesis is severe and prevents the nutrients and medications necessary to regulate blood glucose levels from reaching the bloodstream.

Parenteral nutrition: An alternative to the jejunostomy tube is parenteral nutrition, in which nutrients are delivered directly into the bloodstream, bypassing the digestive system. The physician places a catheter in a chest vein, leaving an opening on the outside of the skin. A bag with liquid nutrients or medication can be attached to the catheter, allowing the fluid to enter the bloodstream through the vein.

Electrical Gastric Stimulation: An area generating a great deal of interest and research is the use of electrical stimulation to enhance gastrointestinal activity. This technique uses electrodes that are surgically or endoscopically attached to the stomach wall and when stimulated, trigger stomach contractions and increase the rate of emptying. In a few studies gastric stimulation or “pacing” has been shown to make disordered gastric motility normal and decrease symptoms of nausea and vomiting in gastroparetic patients. Further studies will help determine who will benefit most from this procedure. Only a few centers across the country perform gastric stimulation procedures.

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