Gastroparesis Symptoms, Causes, Diagnosis, and Treatment

Gastroparesis (GP) refers to when the stomach takes longer than usual to empty its contents into the small intestine. Sometimes referred to as delayed gastric emptying, a lazy stomach, or stomach paralysis, gastroparesis affects 16% of the U.S. population and can stem from a variety of potential causes, making diagnosis and treatment challenging.

According to Dr. Kais Zakharia, an advanced endoscopy and gastroenterologist with Baystate Gastroenterology, GP can have a profound impact on daily living, but “understanding its causes, diagnosis, and ever-increasing treatment options can help with symptom management and quality of life.”

What is Gastroparesis?

As Dr. Zakharia explains, in a healthy individual, food usually passes from the stomach to the small intestine in two to four hours. In that time, the muscles of the stomach contract to mix food with digestive juices to break it down into small particles. Once it’s broken down, those same muscles push the food into the small intestine through the pyloric valve.

“However,” he notes, “for people with GP, both digestion and the movement of food are slowed or don’t happen at all due to the stomach muscles not contracting properly. Instead, food sits in the stomach, leading to a range of uncomfortable symptoms.”

Symptoms of Gastroparesis

Gastroparesis symptoms include:

• Nausea and vomiting
• Feeling full quicker than normal
• Upper abdominal pain
• Bloating
• Loss of appetite
• Acid reflux
• Heartburn

In severe cases, gastroparesis can lead to weight loss and malnutrition.

What Causes Gastroparesis?

While several things can contribute to or cause gastroparesis, for 30-50% of patients, the cause is unknown, or idiopathic.

Some commonly recognized causes include:

• Diabetes: Roughly 25% of all patients diagnosed with GP have either type 1 or type 2 diabetes. Over time, uncontrolled sugar levels damage the nerves surrounding and going into the stomach, leading to GP.
• Viral infections: Common gastrointestinal viral infections, including COVID-19 and norovirus, that cause gastrointestinal symptoms (e.g., abdominal pain, nausea, vomiting, diarrhea, constipation, bloating, heartburn, and indigestion) can contribute to GP. In some cases, symptoms of GP go away on their own months or years after the initial illness.
• Surgery: Certain surgeries are thought to contribute to GP; specifically, surgeries that change the stomach due to the formation of scar tissue or damage to the vagus nerve.
• Medication: Use of medications that block the nerve signals that activate your stomach muscles can lead to temporary GP. These include narcotic pain relievers, calcium channel blockers, antispasmodics, some antidepressants, and certain medications for diabetes, including Ozempic.
• Marijuana: Some research suggests that cannabis may slow down the process of gastric emptying, which can trigger GP or contribute to worsening symptoms.

Getting a Gastroparesis Diagnosis

According to Dr. Zakharia, the first step in diagnosing gastroparesis is ruling out other conditions.

“We typically start with a medical history and physical exam to get a clear picture of all the factors that might contribute to a patient’s problem,” he says. “Previous surgeries, medical conditions, and current medications all provide insight.”

The next step in diagnosing GP is performing an endoscopy to ensure there is no blockage in the stomach or upper intestine. This involves inserting a thin, flexible tube with a camera (called an endoscope) through the mouth into the stomach and upper small intestine.

“If no blockage is found,” says Dr. Zakharia, “we move onto a gastric emptying test.”

Considered the gold standard for diagnosing GP, a gastric emptying test involves eating a meal with a small amount of radioactive tracer. A special camera is used to track how quickly your stomach empties.

“As noted before,” says Dr. Zakharia, “a healthy stomach typically empties in two to four hours. If the test reveals the stomach is still 50% full at four hours, we can confirm a diagnosis of GP.”

Gastroparesis Treatment Options

In the same way that GP symptoms can range from uncomfortable to debilitating, treatment options run the gamut from simple to complex.

For mild cases of GP, initial treatment options include:

• Dietary Changes: Eating smaller, more frequent meals that are low in fat and fiber can help manage symptoms. Liquid or pureed foods may be easier to digest.
• Blood Sugar Control: For people with diabetes, managing blood glucose is crucial.
• Proper hydration and nutrition: Proper hydration and nutrition is essential to overall health.
• Medications: Drugs can help stimulate stomach muscle contractions (prokinetics and antibiotics) or control nausea and vomiting. NOTE: As medications often come with significant side effects, including infertility and involuntary muscle movements, long-term use is NOT recommended.

Dr. Zakharia notes that, unfortunately, these initial treatment options tend to work for only 70% of patients. For the remaining 30%, next-step options include:

• IV Nutrition: When nutrition is a concern, intravenous nutrition may be required.
• Decompression and feeding tubes: For severe cases, a tube may be inserted in the stomach to vent gas and drain fluid to provide relief from symptoms. In addition, a tube may be inserted in the small bowel to provide nutrition and bypass the stomach.
• Surgery and procedures: While there are surgical options for gastroparesis, the most promising and effective approach is a minimally invasive procedure called gastric per-oral endoscopic myotomy, or G-POEM.

Currently, Baystate is the only healthcare facility in western Massachusetts performing the relatively new G-POEM procedure.

Dr. Zakharia explains how it works:

“G-POEM involves cutting the pyloric muscle between the stomach and the small intestine. While it doesn’t increase contractions of the stomach, it does remove the barrier between the stomach and the small intestine, so that the contractions that are happening can more effectively move food out of the stomach.”

While the procedure itself takes 30-45 minutes to perform, and most patients go home the same day, Dr. Zakharia notes that preparing for G-POEM may take up to a week.

“Depending upon the medications a patient is taking, it can take a week to clear the drugs from their system,” he explains. “It’s important to talk to your doctor about all the medications you are taking and developing a plan for how and when to stop their use if needed prior to G-POEM.”

Most patients are able to go home a few hours after the procedure but need to follow a liquid diet for 24 hours and take an antibiotic for five to seven days.

Of all the treatments for symptoms of gastroparesis, G-POEM offers the highest rate of success and the lowest rate of complications.

“Post-procedure analysis has found a 75% success rate after 36 months and very low rates of adverse effects,” says Dr. Zakharia. “While the efficacy of G-POEM compared to surgical options offered elsewhere is similar, the length of time required to complete G-POEM and the length of post-procedure stay are significantly less.”

Living with Gastroparesis

As challenging as gastroparesis is, Dr. Zakharia notes it is possible to live well with the condition.

“It’s important to ask questions of your doctor to ensure you understand the condition, available treatment options—including the risks, benefits, and potential side effects. Again, there’s no cure for gastroparesis, but there are ways to manage the symptoms and live a productive and happy life.”