How is Gastroparesis Treated?

Jan 18, 2017 by

You can have me read this article to you instead of reading it yourself…

Or you can read it the old-fashioned way below…


Providing a thorough and clear explanation of the various treatments for gastroparesis is out of the scope of an online article.  In fact, it falls more into a good topic for a book.  (Yeah, you saw this coming!).  I do discuss the details of treatments for gastroparesis in excessive detail in my book.

The book covers the small number of drugs that are used to actually treat the delayed emptying associated with gastroparesis, as well as the many medications that we must use in order to control our symptoms.  I even talk about medications that are used for other conditions that might overlap with gastroparesis.  And I don’t leave out the discussion of non-medication treatments either – there is a bunch of information on feeding tubes, surgeries, and the gastric neurostimulator.

Another highlight of the information in the book is the discussion on the way that gastroparesis can alter our absorption of any drug, including drugs that are used to treat other conditions.  This has a pretty large impact on our ability to take medications and achieve benefits from them, so I go into great detail on what is happening and some of the options available to get around it.

While I’m not here to sell you the book, I do believe it is your best resource for this information.  There is a free chapter available on the topic of acid reflux right here that will allow you to see what kind of information is covered.

If you’re curious about the topics that I cover, here’s a copy of the Table of Contents.

Gastroparesis Treatment Options

Now that I have laid all of that on the table, I would at least like to provide a general overview of the treatment options available for gastroparesis.

First of all, it’s important for me to state here that there are no cures for gastroparesis.  And when it comes to treatments, there are a very limited number of options that actually treat the cause of gastroparesis – delayed stomach emptying.  The rest of the treatments for this condition are efforts to manage the symptoms that it produces.

Treatments for Delayed Emptying

Medications

There are some drugs available which work by altering the motility of the stomach.  These drugs are called prokinetics, because they promote movement of the muscles.

This list includes the following:

  • Erythromycin (Erythrocin)
  • Metoclopramide (Reglan)
  • Domperidone (Motilium)
  • Cisapride (Propulsid)

This is a very short list, and if you are at all familiar with the medications on this list, you will know that the last two, domperidone and cisapride, are not actually available for use in the United States.  There are a number of ways that people get around this, some more legal than others, which is a topic that I devote time to in the book.

Not only is it a short list, but the drugs on this list are only somewhat effective.  Some people experience great benefits from taking one or two of these medications, while others will experience no benefit from any of them.  The good news is that they work pretty quickly (all of these drugs are taken immediately before eating), so you should know within a few days whether or not they are helping.

On the flip side, it is important to be aware of whether or not these medications are actually helping.  Some of them do have side effects that should be taken into account if you plan to use the medication for a long time.  So if it is not actually providing any benefit, then it is not worth it to keep using it.

I do have an entire Q&A dedicated to the topic of medications and how they are used to treat gastroparesis and it symptoms.  We cover who should/not use them and many of the considerations (including side effects) regarding medications, nutritional choices, and lifestyle changes.  If you have the time (or a long car ride), check it out!

Gastric Neurostimulator

The list above is all that we currently have available to us for medications that treat delayed emptying.

The only non-medication option that we have for treating this is the gastric neurostimulator, a device that delivers electricity (high frequency, low energy) to the muscles of the stomach wall.  If you have read my About page, you will know that I had one of these implanted after 6 years with gastroparesis.

The most important thing that I can tell you is this – the neurostimulator does not ‘fix’ your stomach or get it moving again.  Instead, the stimulation it provides seems to work by reducing feelings of fullness, pain, and nausea.

So as opposed to being a one-and-done treatment, the neurostimulator should be seen more as a piece of your management plan.  And it is a piece that many people will never need because they will be able to control their symptoms adequately through diet and lifestyle changes.  It does seem to be particularly helpful for certain groups of people, including those with diabetes and those that have required the use of feeding tubes, but there are also others that have had the stimulator implanted and have not seen any improvement.

This is a device that requires expensive surgery with a difficult recovery.  It is implanted into the body indefinitely and the battery requires replacement every 5-10 years.  Having an implantation does result in some restrictions, including an inability to get an MRI or scuba dive, and they can prove concerning or dangerous during pregnancy.  These are simply considerations to keep in mind before leaping forward toward this option prior to trying the others first.  But it is a real option that has provided real results for some people.

Botox (Botulinum toxin)

I was hesitant to even include this one here because I wouldn’t call it a treatment at all.

My reasoning behind this is that it has been shown to not work.  That’s right – in studies that compared it to placebo, it provided no benefit whatsoever.  The medical guidelines for managing gastroparesis recommend against this procedure because it is ineffective.

But I’m getting ahead of myself.  The idea behind this particular treatment was that injecting Botox (and yes, it is one and the same with that famous wrinkle-eliminator) into the muscles around the pyloric sphincter could cause it to loosen.  This could theoretically allow food to more readily flow out of the stomach and into the small intestine.   This was done through an upper endoscopy procedure and was to be repeated every 2-3 months.

Unfortunately, it was ultimately a bust.  And more unfortunately, doctors are STILL performing this procedure and presenting false hope to their patients.  If you would like some tales of placebo effects and interesting studies that I personally geeked out on, you can find them in the book.  But I won’t tell them here because boy do I know that the things I geek out over are not for everyone!

Treatment for Gastroparesis Symptoms

Other than what we’ve already discussed (and a small number of highly invasive and rarely performed surgeries), that’s all that we’ve currently got for treating delayed emptying.

All the other treatments are focused on treating our symptoms.  So we have a slew of medications, lifestyle modifications, and diet considerations for some of our more common issues, including:

  • Acid reflux
  • Constipation
  • Nausea and Vomiting
  • Abdominal Discomfort
  • Nutritional Deficiencies
  • Fatigue

 

 


 

 

It is difficult to provide abbreviated advice and information on treatment options and considerations.  That is a topic better covered in depth, with adequate focus placed on benefits, risks, and the types of situations that people may find themselves in.  Even this in-depth, focused information should be discussed with a doctor that is familiar with your situation.  And finally, solid foundational knowledge and understanding for your body and your condition is necessary prior to applying the information found in these discussions.

These are the reasons that the information you may be looking for is currently being trapped in book form.  My goal is always to make valuable information readily available to anyone that needs it, as you can see on this site.  There are just times when that valuable information must be provided in a different setting.

Now that we’ve covered all of the basics of gastroparesis, where do we go from here?

Interested in more information on Gastroparesis?

Next: What is a Gastroparesis-Friendly Diet?

Or refer back to the Gastroparesis Info Hub.

 


Trivia and Terminology:

The Brand Names for 3 of the medications that treat gastroparesis actually imply what they are supposed to do in their names.  Hopefully someday someone will find a medication that actually does those things for all of us.

Gastroparesis is Greek for “partial paralysis of the stomach”

 

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