Ask the Pharmacist

Q) My stomach has been bothering me for a long time now. My diabetic specialist says he thinks I am suffering from gastroparesis. What the heck is that?

A) The literal translation of gastroparesis is stomach paralysis and that’s probably as good a description of the condition as you can find.

It is a condition that occurs when your stomach cannot empty itself of food in a normal amount of time despite the fact that there is nothing obstructing the outflow of that food. It doesn’t seem to occur for any single reason but rather arises from damage to nerves and special cells, in particular the vagus nerve which controls the muscles of the stomach and small intestine and the pacemaker cells that line the walls of the stomach and are partly responsible for allowing the stomach to empty.

In 25% of the people diagnosed with gastroparesis, this damage arises as a long-term complication of diabetes, which is just another reason that good control of your blood sugar levels is so essential.

Others have this condition as a by-product of a number of possible causes including an underlying connective tissue or autoimmune disorder, as a complication after having had gastric surgery or as a result of taking certain medications (most commonly the opioid painkillers, the proton pump inhibitors that lower stomach acid and the tricyclic antidepressants such as amitriptyline that are used for sleep, treating nerve pain and a host of other conditions).

It’s hard to find statistics indicating how prevalent this condition is in Canada but it is estimated that there are 4 to 5 million Americans affected by this to some degree.

Like so many other chronic conditions, gastroparesis is associated with a decreased ability to perform daily activities (67.5% report this), lower annual income due to sick days (28%) and 11% described themselves as disabled as a result of their symptoms. The symptoms are what you would expect from a stomach that has problems emptying. These include feeling full soon after starting a meal (60% of patients), feeling full long after eating a meal, nausea (90%), vomiting (84%), pain in your upper abdomen (90%), bloating, belching, heartburn and a poor appetite. Given the challenges in eating while living with this condition, it is no great surprise that weight loss, malnutrition and dehydration are all possible complications if the condition is severe enough.

Gastroparesis can be diagnosed by a physical exam and a number of tests including a barium X-ray, gastric manometry (a procedure in which a thin tube goes through your mouth to your stomach and measures its electrical and muscular activity) or a radioisotope gastric-emptying scan (a procedure in which you eat food that contains a small amount of a radioactive substance which is then monitored on a scanner).

There are no cures but there are a number of interventions that can help ease the symptoms. The first step is to modify the diet aiming to make meals smaller but more frequent (4 to 6 a day) while limiting the amount of fat and fiber (which tend to delay stomach emptying). Supplementing with high-calorie liquids (like Peptamen 1.5) to help meet nutritional needs can be useful when warranted. Ideally food should be soft and well-cooked and alcohol and carbonated beverages should be avoided.

The drug metoclopramide has been available for many decades now and is the only one approved in the United States for treating gastroparesis. It works by stimulating stomach muscle contractions to help move the food along. It is usually taken four times a day, at bedtime and 20 to 30 minutes before three of the meals. It seems to help a great many particularly in reducing the nausea and bloating. It may cause some degree of drowsiness but is generally considered a very safe medication.

Other drugs that might be of benefit include domperidone and the antibiotic erythromycin. Other treatment options include gastric electrical stimulation (electrodes are attached to the stomach wall and when activated trigger stomach contractions), surgery (including the insertion of a J-Tube that allows feeding of liquid foods directly into the intestines) and the injection of Botox into the valve that leads from the stomach to the intestines.

While gastroparesis cannot be cured at this point in time, with a diligent diet and the help of medications most diagnosed with this condition will get some relief at least and be able to live a full and happy life.