Going to the doctor can be stressful, adding up to all the symptoms you already have but being a good gastroparesis patient isn’t just listening to your doctor. It is equally important that you listen to yourself as well including getting the treatment you need. Understanding the condition, the treatment options, your symptoms, and how you respond to lifestyle modifications and treatment will be the best navigation tool for finding what works best for you. So to help you be more proactive with managing the condition, we will list down available treatments and what you should expect as most of the treatments are geared towards symptom control rather than a cure for the underlying problem. Just know that every individual is unique and some don’t always respond to treatment the way the body is expected to. It is still best to go see your doctor to tailor the care plan for you and your individual needs.
CONSERVATIVE TREATMENT OPTIONS
The first line of treatment will be to modify the diet. Follow the gastroparesis diet which is low fat, low fiber, low sugar, and small frequent meals. This will entail avoiding fried, acidic, spicy, and sugary, high-fiber foods, and big meals in one sitting. All of these can irritate the stomach and lead to increased symptoms, particularly of pain and bloating. Eating small frequent meals will help the stomach lessen the load with emptying.
Antiemetic or anti-nausea medications include Zofran or Phenergan which helps control symptoms of nausea and vomiting although they do not improve gastric emptying. While prokinetic or promotility medications stimulate the stomach muscles to increase stomach emptying. The most common prokinetic is Reglan increasing the tightening or contraction of the stomach muscles but with a warning for serious side effects. Other medications include Compazine (anti-psychotic), Benadryl (antihistamine), and Diclegis (used to treat nausea and vomiting in pregnancy) which can all help with the control of symptoms of nausea and vomiting.
INVASIVE TREATMENT OPTIONS
Botulinum toxin injection into the pyloric sphincter is a simple procedure that is performed with an upper endoscopy. This procedure is also called “chemical pyloroplasty,” with the botox relaxing the pylorus so that food can empty the stomach faster. This treatment is less invasive and less expensive compared to pyloroplasty surgery but can only help patients for approximately 90 – 120 days.
Pyloroplasty is a surgery to widen the pylorus, or the valve in the lower part of the stomach, allowing food to empty into the small intestine. This procedure involves cutting through and removing some of the pyloric sphincter to widen and relax the pylorus making it easier for food to pass through without difficulty or obstruction.
The gastric neurostimulator is a small programmable device implanted in the muscle of the stomach. It generates mild electrical pulses to stimulate the smooth muscles of the stomach to treat chronic, intractable nausea and vomiting associated with gastroparesis. The device can be adjusted to the settings that work best for the patient with a handheld external programmer. The stimulator is not a cure and the goal of therapy is 80% improvement of the symptoms. If the device is turned off or other issues arise keeping the device from working, then the symptoms will recur. It is indicated for patients who have exhausted medical management before consideration for a device implant.
For more severe cases that don’t typically respond well to therapy including oral medications and surgery, IV infusion and medications are started to prevent dehydration due to persistent vomiting. IV medications also act faster without the need to be absorbed in the small intestine wherein gastric emptying into it is an issue with gastroparesis.
Once oral intake is not tolerated causing malnutrition or malnutrition becomes a bigger issue due to poor absorption or low-calorie intake, patients are given other sources/routes for nutrition. Patients can start tube feeding where liquid nutrition is delivered through a flexible tube that goes in through the nose or direct to the stomach/small intestine but if tube feeds are still not tolerated, then a patient can be put in total parenteral nutrition (TPN). TPN is an IV-administered nutrition that is the only source of nutrition the patient will be receiving.
Most of the time, no single treatment helps all gastroparesis patients. All these treatment options have risks, some more than others. Risks can be unavoidable for some, while others can be avoided and/or managed accordingly. Patients and families need to plan care with the doctor or the healthcare team to maximize benefits and minimize risks.
Gastroparesis is a chronic condition with no cure that greatly impacts the quality of life and well-being. Living with this condition affects not only those diagnosed with it but also others, especially patient’s loved ones. It can affect relationships in school, in the workplace, and other social interactions. It is difficult to function like you would normally when you constantly experience debilitating symptoms. While some cases are refractory and do not respond too well to treatment, doing your part in finding and noting what helps you can and will make a difference.
It will take a great deal of courage, strength, and effort to deal with this challenging disease while advocating for better health. You have to constantly research for developments in treatment, always looking for what helps with your symptoms and what doesn’t, what hurts, and what works best for you. It will be difficult for most, but there is always a possibility that it can get better. We have had many patients respond well to treatment and for others who don’t typically respond as expected, we find more ways to cater to their needs. It is imperative to understand that you are not alone, we, your healthcare providers, and organizations working on research and advances in treatment, and your loved ones are here for you. We see you and we hear you. Now join us in seeing and hearing you work on finding the best quality of life while living with gastroparesis.
