Gastroparesis is a progressive disorder that has a long term course with no specific cure. However, several diet and medical treatments are available that can help control the symptoms and delay the progression of the condition to some extent while improving the quality of life of the patient.
The treatment modalities of gastroparesis include:-
Patients are advised to take six smaller meals instead of three large major meals. Small amounts of food in the stomach help in reducing the load over the stomach muscles and reduce symptoms.
Foods should be soft, well chewed and chosen carefully. Foods high in fibre, fats, carbonated and fatty drinks should be avoided.
Medications include prokinetic agents
These agents speed up the propulsive movements of the stomach and lead to more rapid emptying of the stomach. One of the most commonly used agents of this group is Metoclopramide. This is usually taken before eating to contract the stomach muscles and move food to the intestines. This reduces nausea and vomiting.
Metoclopramide acts on dopamine receptors in the stomach and intestine as well as in the brain. It also acts on the vomiting center of the brain and thus reduces the vomiting and nausea.
Use of this medication is limited in some people due to the side effects of dystonia, agitation and muscle twitching or “tardive dyskinesia”.
Other side effects include diarrhea, insomnia, depression and painful breast swelling and nipple discharge in both men and women. This agent cannot be taken over long term.
Domperidone is another commonly used safer prokinetic agent. It also acts on dopamine receptors. Domperidone does not have the side effect of tardive dyskenisia that are seen with metoclopramide because it acts mostly on peripheral receptors, rather than in the brain.
Erythromycin is an antibiotic that has prokinetic effects and may be used on gastroparesis. It acts by binding to receptors in the stomach and small intestine called motilin receptors. Stimulation of motilin receptors helps in muscle contractions.
Cisapride is another agent in this class. It binds to serotonin receptors located in the stomach walls that contracts the stomach and moves food forwards. In the late 1990’s cisapride was banned from use due to complications of heart arrhythmias or rhythm disturbances seen in patients who were using this drug. It is once again available but its use is restricted.
Some medications are prescribed to reduce the symptoms of nausea. These belong to a class of agents called antiemetics.
Severe cases of gastroparesis can also be treated by injecting botulinum toxin (Botox). The injection is given into the valve between the stomach and the intestine to keep it relaxed and open for longer period of time so food can pass through.
The injection is given via an endoscope (thin flexible tube), that is passed into the stomach via the throat.
Gastric electrical stimulation
In this method a battery-operated device is surgically implanted into the body. This acts as a pacemaker and releases electrical impulses. The electrodes are fixed to the muscle of the lower stomach and the connector end of each lead is attached to the neurostimulator, which is implanted under the skin of the abdomen.
Severe cases may require feeding tubes. These tubes are used to transmit the food directly into the upper part of the small intestine or jejunum, bypassing the stomach.
A temporary feeding tube called a nasojejunal tube may be offered initially. The tube is passed through the nose into the jejunum and food is transmitted.
If required over long term, a feeding tube can also be inserted directly onto the jejumum via a surgical incision over the abdomen. This is known as a jejunostomy.
Liquid food containing nutrients can be poured into the tube and this bypasses the stomach and the esophagus. The tube may also be implanted into the stomach. This is called gastrostomy.
If tube feeding is not possible, nutrients and calories are given to the patient as injections and intravenous infusions. This is needed in severe and very advanced cases.
Surgery is performed to create an opening between the stomach and the intestines to allow easy passage of foods. This is known as a gastroenterostomy.