University of Wisconsin–Madison

Diagnosis and Treatment Options for Gastroparesis

By Amber Shada, MD

Gastroparesis, which translates to “weak stomach,” is a condition where the stomach does not work properly. The stomach’s primary function is to move food through the upper digestive tract with strong contractions. In gastroparesis, the stomach has difficulty moving its contents into the small intestine. This leads to nausea, vomiting, bloating, reflux and abdominal pain.

The majority of patients we see with gastroparesis acquired the disease for an unknown reason (idiopathic); however, diabetic neuropathy and damage to the vagus nerve, often during prior esophagus or stomach surgery, are known causes. There is also some evidence to suggest gastroparesis can be caused by viruses, neurological disorders, autoimmune diseases, hypo and hyperthyroidism, mitochondrial disease, and eating disorders.

Diagnosis

When patients have symptoms of gastroparesis, we often recommend a gastric emptying study to confirm the diagnosis. A gastric emptying study involves the patient eating a meal, usually scrambled eggs, labeled with trace amount of radioactive material. Scans are then taken of the patient at different time intervals, up to 4 hours, to watch the progression of the meal through the stomach. Calculating the remaining amount of stomach contents at the end of each interval will determine whether gastroparesis is present.

Treatment

The goal for treatment of gastroparesis is to decrease symptoms like nausea or bloating. There is no cure for gastroparesis, and most people require a combination of treatments. Eating frequent, small meals that are low in fat and fiber can help minimize symptoms. Liquid calories, such as those in milkshakes, are usually well-tolerated. This is the primary reason that, despite having a nonfunctional GI tract, there are patients with gastroparesis who are overweight or have gained significant weight even as their nausea, vomiting or bloating have worsened. There are a variety of medications available to manage nausea and promote stomach contraction. Pain medications like opioids are not recommended, as they slow stomach emptying.

When dietary changes and medications fail to control symptoms of gastroparesis, then surgical treatment is considered. There are a variety of procedures available, and their use is tailored to each individual depending on their symptoms. These procedures are detailed below.

  • Pyloroplasty. This procedure permanently opens the valve at the bottom of the stomach, allowing contents to pass more easily into the small intestine. This procedure is done minimally invasively.
  • Gastric nerve stimulator. This device implants electrodes into the wall of the stomach that act to increase the stomach’s motility. The electrodes are connected to a transducer in the abdominal wall that carries impulses to the stomach. This device can be accessed transcutaneously (across the skin without use of needles) to monitor strength of contractions and for device maintenance. Impulse contractions can be set to optimize control of nausea, vomiting, bloating and other symptoms related to gastroparesis.
  • Gastrostomy tube. This plastic tube, also known as a G tube, enters the stomach from the abdominal wall. This allows the patient’s stomach to vent and drain air and fluid that would normally cause bloating, nausea and distension of the abdomen. This can be helpful as part of another procedure or on its own.
  • Jejunostomy tube. This plastic tube enters the intestine through the abdominal wall. This allows nutritional supplements to bypass the stomach and can provide nutritional support when the diseased stomach is not able to move enough food through to meet nutritional needs.
  • Gastrectomy. Removal of the stomach is an operation of last resort. During this operation a surgeon removes the diseased stomach, which allows food to go directly from the esophagus into the small intestine. Surprisingly, even complete removal of the stomach does not eliminate nausea and symptoms from gastroparesis in all individuals.

For more information

Gastroparesis is a frustrating and complex disease that requires expertise from gastroenterologists, dieticians and, in some cases, surgeons. Our surgery department has more than 15 years of experience caring for patients with gastroparesis. For questions about a patient or a referral, call the General Surgery Clinic at UW Health at The American Center at (608) 440-6300.