Gastroparesis is also often referred to as delayed gastric emptying. The term “gastric” refers to the stomach. Usually, the stomach voids its contents in a disciplined fashion into the small intestine. In gastroparesis, the muscle contractions that allow the food to move along the digestive tract do not function normally and the stomach does not empty quickly enough. Gastroparesis is defined by long-term symptoms combined with postponed stomach emptying in the absence of any observable obstruction or blockage. The delayed stomach emptying is confirmed by a test.

What causes gastroparesis?

The cause of gastroparesis is often unclear. However, it has been observed that in many cases, gastroparesis is caused by damage to the vagus nerve (an important link from the gut to the brain.)

The vagus nerve is responsible for managing the intricate mechanisms in your digestive tract, including communicating to the muscles in your stomach when to contract and move food into the small intestine. An impaired vagus nerve cannot signal normally to your stomach muscles. This causes food to remain in your stomach for a longer period of time, rather than pushing into your small intestine to continue the digestion process.

Factors that cause vagus nerve damage can be attributed to diseases, such as diabetes, or by surgery to the stomach or small intestine.

Who is at risk of gastroparesis?

• People with diabetes
• People who have had abdominal or esophageal surgery
• People who have suffered an infection, or a virus
• Certain medications can slow the rate of stomach emptying, such as narcotic pain medications
• People with scleroderma (a connective tissue disease)
• People with nervous system diseases, such as Parkinson’s disease or multiple sclerosis
• People with hypothyroidism (low thyroid)
• Women are more likely to develop gastroparesis than men

It is important to understand that many people with gastroparesis don’t show any observable signs or symptoms. However, if you are showing signs of the following symptoms, consult your physician:

• Vomiting
• Nausea
• A feeling of fullness after eating just a few bites
• Vomiting undigested food eaten a few hours earlier
• Acid reflux
• Abdominal bloating
• Abdominal pain
• Changes in blood sugar levels
• Lack of appetite
• Weight loss and/or weight gain
• Tooth decay

Complications of gastroparesis

• Severe dehydration: Frequent vomiting can contribute to dehydration
• Malnutrition: Lack of appetite leads to low caloric intake, and results in an inability to absorb enough nutrients. These symptoms can lead to weight loss. 
• Undigested food that hardens and remains in your stomach: Foods that remain undigested in the stomach can solidify into a hardened mass called a bezoar. These solid masses cause nausea and vomiting and can be life threatening due to the prevention of digestion.
• Unpredictable blood sugar changes: Gastroparesis does not directly cause diabetes, however it can lead to irregular changes in blood sugar levels. This can aggravate an existing case of diabetes and make it more difficult to manage.
• Decreased quality of life: Gastroparesis flare ups can cause discomfort and affect an individual’s ability to perform normal day to day activities.

Physical exams will be performed by a doctor if gastroparesis is suspected. Inform your doctor about any medications you are taking. A test that measures how fast the stomach empties is done to confirm the diagnosis. The following tests are performed by doctors to help diagnose gastroparesis and rule out conditions that may cause similar symptoms. Tests may include:

Gastric emptying study:

This test involves eating a light meal that has a small amount of radioactive material. The radioactive material is monitored by a scanner that identifies its movement. This enables the doctor to monitor the rate/speed of gastric emptying.

You’ll need to stop taking any medications that could slow gastric emptying. Ask your doctor if any of your medications might slow your digestion.

Upper gastrointestinal (GI) endoscopy:

This process is done to examine your upper digestive system — your esophagus, stomach and beginning of the small intestine (duodenum). A microscopic camera is placed on the tip of a long, malleable tube. This procedure can also diagnose other digestive conditions, such as peptic ulcer disease or pyloric stenosis, which all have similar symptoms to gastroparesis.

Ultrasound:

This procedure uses sound waves to develop images of masses within your body. Ultrasounds assist in diagnosing whether problems with your gallbladder or your kidneys could be the root of your symptoms.

Upper gastrointestinal series:

This is a series of X-rays in which you drink a white, chalky liquid (barium) that coats the digestive system to help abnormalities show up.

Treating gastroparesis

The first step in treating gastroparesis is treating the root cause or underlying condition. If it is diabetes your doctor will work with you to control it. A dietitian might suggest that you try to:

• Eat smaller meals more frequently 
• Chew food thoroughly 
• Eat well-cooked fruits and vegetables rather than raw fruits and vegetables 
• Avoid fibrous fruits and vegetables, such as oranges and broccoli, which may cause bezoars 
• Choose mostly low-fat foods, but if you can tolerate them, add small servings of fatty foods to your diet 
• Try soups and pureed foods if liquids are easier for you to swallow 
• Drink about 1 to 1.5 liters of water a day 
• Exercise gently after you eat, such as going for a walk 
• Avoid carbonated drinks, alcohol and smoking 
• Try to avoid lying down for 2 hours after a meal 
• Take a multivitamin daily

Medications for gastroparesis:

Gastroparesis is a debilitating stomach disease for which there is no cure. However, there are a few medications for gastroparesis that may help mask symptoms and make life more manageable.

Despite the debilitating nature of the disorder, gastroparesis is sorely lacking in available resources for patients in the way of education and awareness. So, we (successfully) petitioned this year to make August the official gastroparesis awareness month. In our efforts to raise both funds for research and awareness this month, we also wanted to develop some resources that we felt would be an asset to someone who is newly diagnosed.

CDHF worked together with gastroparesis patient and advocate; Jennifer Ouellette, to put together a list of medications for gastroparesis. This detailed and comprehensive list will walk you through each medication, its uses, the potential side effects, and risks, along with some insights from Jennifer herself.

If you’re newly diagnosed and would like a deeper look into what medications for gastroparesis might make an appearance in your treatment plan, feel free to take a read or share with your doctor.

This list of medications for gastroparesis is meant for general information only and is not intended to replace any advice you may have already received from your healthcare practitioner.

Medications to treat gastroparesis may include: 

• Medications to stimulate the stomach muscles 
• Medications to control nausea and vomiting

12 Medications for Gastroparesis:

Domperidone (motilium)

Is one of the most commonly prescribed medications for gastroparesis, and usually the first treatment option that is offered. It does pose cardiac risk so it is recommended to have an electrocardiogram before starting and to continue to have cardiac activity monitored while on the medication. It can be used long term but you should be monitored by a doctor while on the medication. It works as an antiemetic and as a gastric prokinetic. It is supposed to help with nausea and vomiting as well as help speed up the gastric emptying time. This is the drug that I was on for 4 times a day for almost 10 years before it stopped working. It kept a lot of my symptoms calm with an occasional flare-up happening every once in a while.

Common Side Effects 

• breast pain
• diarrhea
• dry mouth
• headache
• migraine
• nausea
• rash

Rare but more serious side effects:

• breast milk flowing from the nipple
• fast, pounding, or racing heartbeat or pulse
• menstrual irregularities
• swelling of the breast (males)

Do not take domperidone if you:

• are allergic to domperidone or any ingredients of the medication
• are taking the medication ketoconazole
• are taking medications which cause QT prolongation
• have bleeding in the stomach or intestines
• have a blockage in the stomach or intestines
• have breaks in the lining of the stomach or intestines
• have a prolactinoma (a tumour of the pituitary gland)
• have uncorrected levels of potassium, magnesium, or calcium in your blood
• have cardiac disease (e.g., heart failure)
• have QT prolongation (a type of irregular heartbeat)
• have moderate or severe liver impairment

Metoclopramide (also known as Maxeran or Reglan or Metonia)

Despite some troublesome side effects, Metoclopramide is also one of the more commonly prescribed medications for Gastroparesis. Like Domperidone, it is supposed to help relief nausea, vomiting and also help with speeding up gastric emptying times and also help with reflux. It poses a risk of developing serious side effects such as Tardive Dyskenesia and Neuroleptic malignant syndrome. I was on the liquid form of this medication and started developing neurological twitches that could have turned into Tardive Dyskensia and been permanent. Thankfully for me, they went away after stopping the medication but that is unfortunately not the case for everyone.

Common Side Effects

• diarrhea (with high doses)
• dizziness
• drowsiness
• fatigue
• restlessness or difficulty sleeping

More serious side effects to watch for:

• chills
• difficulty speaking or swallowing
• dizziness or fainting
• fast or irregular heartbeat
• fever
• a general feeling of tiredness or weakness
• headache (severe or continuing)
• inability to move eyes
• increase in blood pressure
• lip smacking or puckering
• loss of balance control
• mask-like face
• muscle spasms of face, neck, and back
• puffing of cheeks
• rapid or worm-like movements of the tongue
• shuffling walk
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• sore throat
• stiffness of arms or legs
• tic-like or twitching movements
• trembling and shaking of hands and fingers
• twisting movements of the body
• uncontrolled chewing movements
• uncontrolled movements of arms and legs
• unusual eye movements
• a weakness of arms and legs

Do not take metoclopramide if you:

• are allergic to metoclopramide or any of the ingredients of this medication
• have a condition where faster passage of materials through the stomach might be dangerous (e.g., in cases of stomach bleeding, or breaks in the stomach lining)
• Metoclopramide should not be given to children less than one year of age.

Erythromycin

The same antibiotic that we use to treat bacterial infections also has a use in treating Gastroparesis. It is typically used at a lower dosage, not the same dosing used for antibiotic treatment with the drug.  I was told it shouldn’t be used longer than 4 weeks without a break because of side effect risks. It works by helping to stimulate the receptors that assist in making GI contractions and that helps increase motility in the GI tract. This is one of the medications for gastroparesis that was not effective for me when I tried it but I have heard some people have success with it short term.

Common Side Effects:

• abdominal or stomach cramping and discomfort
• diarrhea
• nausea or vomiting

Rare more serious side effects:

• confusion
• continued diarrhea even after you have finished taking this medication
• irregular or fast heartbeat
• hallucinations
• loss of hearing (temporary)
• nausea or vomiting (severe)
• ringing in the ear
• seizures
• skin rash, redness, or itching
• stomach pain (severe)
• symptoms of liver damage (e.g., yellow skin or eyes, abdominal pain, dark urine, clay-colored stools, loss of appetite, nausea, and vomiting, or itching)
• unusual tiredness or weakness
• vertigo

Erythromycin should not be taken by anyone who:

• is allergic to erythromycin, or to any of the ingredients of the medication
• is allergic to clarithromycin or other macrolide antibacterial agents
• is pregnant
• has preexisting liver disease or dysfunction

Cisapride (Propulsid)

This is one of the medications for gastroparesis that has been banned in many countries. It is still available to my knowledge in Canada through Health Canada Special Access program. It is severely restricted because of the risk of rare but serious cardiac events associated with the drug.  Cisapride works as a gastric prokinetic agent increasing the motility in the GI tract.

Common Side Effects

• Constipation
• Diarrhea
• Stomach Cramps
• Drowsiness
• Nausea
• Headaches
• Low Energy

Rare serious Side effects

• Bronchospasm
• Complete Stoppage Of The Heart
• Confused
• Depression
• Giant Hives
• Hallucination
• Prolonged QT Interval On EKG
• Seizures
• Very Rapid Heartbeat – Torsades De Pointes
• Discharge Of Milk In Men Or Women When Not Breastfeeding
• Enlarged Breasts
• Hives
• Increased Prolactin In The Blood
• Problems With Bladder Control

Prucalopride (Resotran, Resolor)

This is one of the medications for gastroparesis that was part of the clinical trials held in Calgary. It is primarily used as a drug to help treat chronic constipation in women. It has been used by a lot of people in our Facebook support group, including myself. Some people have responded very well to Resotran. It worked great for me for about 6-7 months and then it stopped working. It helped speed up emptying times for me but the trade-off was a great deal of diarrhea.

Most common side effects:

• abdominal pain
• back pain
• diarrhea
• dizziness
• enlargement of abdomen or stomach
• fatigue
• headache
• heartburn
• gas
• loss of appetite
• nausea
• sinusitis
• stomach upset
• tiredness
• vomiting

Rare but serious side effects:

• abnormal heart rhythms (such as fast or slow heart rate, palpitations)
• chest pain
• migraine
• pounding, rapid heartbeat (palpitations)

Do not take this medication if you:

• are allergic to prucalopride or any ingredients of this medication
• have kidney disease that requires dialysis
• have serious problems with your digestive system, such as a tear in the wall of the digestive system, a blockage in the digestive system, or inflammatory disease of the intestine such as Crohn’s disease or ulcerative colitis
• have galactose intolerance or glucose malabsorption (a rare hereditary disease)

Ondasetron (Zofran)

This is probably one of the more common antiemetic medications for gastroparesis that is prescribed. It is a drug that is used most often to treat nausea and vomiting associated with chemo or radiation in cancer patients. Many Gastroparesis patients including myself (until they no longer worked) find that this drug works well to help with nausea.

Common Side effects

• constipation
• flushing or feeling warm
• low blood pressure
• unusual tiredness or weakness

Rare more serious side effects

• blurred vision
• difficulty moving or abnormal body movement
• dizziness
• pain, redness, or burning at place of injection
• rapid pounding heartbeat

Do not take this medication if you:

• are allergic to ondansetron or any ingredients of the medication
• are taking the medication apomorphine

Promethazine (Phenergan)

It is an antihistamine used to treat allergies, nausea, and trouble sleeping. They use this medication a lot to help women with morning sickness during pregnancy. I have used it a few times for nausea and it works decently.

Common Side Effects:

• drowsiness, dizziness;
• ringing in your ears;
• double vision;
• feeling nervous;
• dry mouth; or
• tired feeling, sleep problems (insomnia).

Rare severe Side effects:

• severe drowsiness, weak or shallow breathing;
• a light-headed feeling, like you, might pass out;
• confusion, agitation, hallucinations, nightmares;
• seizure (convulsions);
• fast or slow heartbeats;
• jaundice (yellowing of the skin or eyes);
• uncontrolled muscle movements in your face (chewing, lip-smacking, frowning, tongue movement, blinking or eye movement);
• easy bruising or bleeding (nosebleeds, bleeding gums);
• sudden weakness or ill feeling, fever, chills, sore throat, mouth sores, red or swollen gums, trouble swallowing; or
• very stiff (rigid) muscles, high fever, sweating, confusion, fast or uneven heartbeats, tremors, feeling like you might pass out.

Relamorelin

It is a new drug being trialed currently with diabetic Gastroparesis patients here in Canada. As I have idiopathic Gastroparesis I have not had a chance to trial this drug as of yet.

https://ucalgary.ca/motility/current-research/treatment-diabetic-gastroparesis-new-clinical-trial

I don’t have a list of side effects yet as they are still testing the drug. The studies have been promising. Showing so far that there have been no cardiac or neurological side effects which would mean it could potentially be a safer option than some of the other medications out there currently.

Botox injections – (not covered in every province)

This seems to be hit or miss among patients who have tried it. My specialist said for my personal case my Gastroparesis it is too severe and it wouldn’t be worth it.  As I am not incredibly familiar with how it all works, so here is the official description of its use in cases of gastroparesis:

“While the patient is sedated, the physician will advance a scope through the esophagus, stomach, and the pyloric sphincter. Botox is injected into the pyloric sphincter in an effort to relax that muscle, enabling food to empty from the stomach more easily. It takes approximately 15-30 minutes.

The effects of the botox may be felt immediately or may take some time to begin working. Complications from the procedure include nausea and vomiting from sedatives. Although rare, some report bleeding, perforation of the esophagus, fever, or severe vomiting.

Botox injections are not a permanent solution and usually last no more than 6 months. Repeat injections do not always produce the same results.”

Linaclotide (Constella)

It is used to treat IBS-C and to treat chronic (long-term) constipation. It seems to be commonly prescribed for Gastroparesis patients who experience chronic constipation as well. It is usually my go-to medication when I am having issues with constipation and while it causes a bit more pain and bloating it does help with relieving constipation.

Common Side Effects:

• loating (swelling or feeling of fullness in your abdomen)
• diarrhea
• nausea
• passing gas
• vomiting

Rare Side effects: 

• new or worsening abdominal pain
• severe diarrhea (persistent watery stools)

Nabilone (synthetic cannabinoids)

Used to treat severe nausea. I know some people in the group have tried this as they can get their insurance to cover the pill form of synthetic cannabinoids but no coverage for actual cannabis. I cannot speak personally about this one as I use actual Medical Cannabis to treat my symptoms.

More Common Side effects:

• blurred vision or any changes in vision
• clumsiness or unsteadiness
• confusion
• dizziness or light-headedness, especially when rising from a lying or sitting position (more common with high doses)
• drowsiness
• dry mouth
• headachee
• loss of appetite
• loss of muscular coordination
• nightmares

Rare more serious side effects: 

• changes in mood (including a false sense of well-being)
• confusion
• convulsions (seizures)
• delusions
• depression
• dizziness or fainting
• fast or pounding heartbeat
• hallucinations
• nervousness or anxiety
• sensation disturbance (unusual sensations or changes in sensations)
• unusual tiredness or weakness (severe)

Medical Cannabis for Gastroparesis

Is one of the most effective medications for gastroparesis, as far as managing symptoms go. Everyone is going to be different and Cannabis may or may not work for everyone.  Finding strains that have proper terpenes to help digestive issues, like Limonene is important when trying to find the best strains to help. This study may be of interest as it is newer research. Hopefully, more research and some clinical trials can happen soon!

With the help of people like YOU, we can raise money and awareness for gastroparesis. Hopefully, in time, new, more effective medications for gastroparesis can be found. Perhaps even a cure!

If you’re interested in helping us work towards abolishing this terrible disorder, please head over to our donation page today and make a contribution!

Surgical treatment for gastroparesis:

Unfortunately, in severe cases, some patients may be unable to handle any food or liquids. In these instances doctors may recommend a feeding tube (jejunostomy tube) be inserted in the small intestine.

Doctors may also recommend a gastric venting tube to help alleviate pressure from gastric build-up. Feeding tubes can be passed through your nose or mouth or directly into your small intestine through your skin. This procedure is usually temporary and is only used when gastroparesis is severe or when blood sugar levels can’t be managed any other way. Some individuals may require an IV (parenteral) feeding tube that goes directly into a vein in the chest.

Lifestyle and home remedies for gastroparesis:

If you’re a smoker, stop. Your gastroparesis symptoms are less likely to improve over time if you keep smoking. People with gastroparesis who are overweight are also less likely to get better over time.

Preparing for an Appointment 

You’re likely to first see your primary care doctor if you have signs and symptoms of gastroparesis. If your doctor agree that your symptoms point to gastroparesis, you may be referred to a gastroenterologist ( a specialist in digestive diseases.) You may also be referred to a dietitian who can help you manage your diet plan.

What you can do:

Because appointments can be quick, it’s important to be well-prepared. To get ready, try to:

• Be aware of any pre-appointment protocols. When you make your appointment, be sure to inquire if there’s anything you need to do in advance, such as restrict your diet. The doctor’s office might request that you stop using certain medications, prior to coming for an appointment. • Record any symptoms you’ve experienced, including any that may not seem related.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, vitamins or supplements that you’re taking.
• Consider taking a family member or a friend with you. It can often be tough to recall all the information provided during an appointment. A friend of family member may be able to help you remember something you forgot down the road.

Questions to ask your doctor if you think you have gastroparesis:

Prepare a list of questions ahead of time to ensure that you optimize your time with your doctor or specialist. Take this list of questions to ask your doctor if you’re worried you have gastroparesis with you to your next appointment:

• What’s the most likely cause of my symptoms?
• Could any of my medications be causing my signs and symptoms
• What kinds of tests do I need?
• Is this condition temporary or long lasting?
• Do I need treatment for my gastroparesis?
• Should I see a dietitian?
• What are my treatment options, and what are the potential side effects?
• I have diabetes, how will gastroparesis affect my diabetes management?

• Gastroparesis is characterized by delayed gastric emptying in the absence of a mechanical obstruction.
• Most cases of gastroparesis (more than one-third) are idiopathic, i.e. have an unknown cause. Other common causes are diabetes and postgastric surgery. (Parkman 2015)
• Patients with idiopathic gastroparesis are typically young or middle-aged women. (Parkman 2015)
• Although the true prevalence of gastroparesis is unknown, US data suggest that it may affect 2% of the general population. (Parkman 2015)
• Gastroparesis is associated with psychological distress and poor quality of life.
• 24% of patients have combined anxiety and depression. (Woodhouse et al. 2017)
• Two-thirds of people affected by gastroparesis report having a poor or fair quality of life. (Yu et al. 2017)
• Nearly one-third (30%) report they are not working because of the condition. (Yu et al. 2017).
• The economic burden of gastroparesis in Canada is unknown.
• In the US, mean hospital charges increased significantly by 159% from US$13,350 in 1997 to US$34,585 per patient in 2013, after adjustment for inflation. At the national level, the costs of hospital visits also increased substantially, by 1026%, from $50,456,642 to $568,417,666. (Wadhwa et al. 2017)

Citations:

_{Parkman HP. Idiopathic gastroparesis. Gastroenterol Clin North Am. 2015 Mar;44(1):59-68.}

_{Wadhwa V et al. Healthcare utilization and costs associated with gastroparesis. World J Gastroenterol. 2017 Jun 28;23(24):4428-36.}

_{Woodhouse S et al. Psychological controversies in gastroparesis: A systematic review. World J Gastroenterol. 2017 Feb 21;23(7):1298-309.}

_{Yu D et al. The burdens, concerns, and quality of life of patients with gastroparesis. Dig Dis Sci. 2017 Apr;62(4):879-93.}