Not considering conditions than mimic gastroparesis
There are several conditions, including several functional gastrointestinal disorders, that can have a similar clinical presentation to gastroparesis and that are associated with delays in gastric emptying (figure 2). These conditions should therefore be considered and systematically excluded to ensure management strategies are adapted appropriately.
First is functional dyspepsia, which is the closest mimic to gastroparesis. Functional dyspepsia can be divided into epigastric pain syndrome and postprandial distress syndrome. Postprandial distress syndrome is characterised by symptoms of early satiety, postprandial fullness, epigastric bloating and epigastric discomfort or pain, symptoms that are almost identical to those of gastroparesis but with less nausea and vomiting. About a third of patients with functional dyspepsia will have mild to moderate delays in gastric emptying. The pathophysiology of functional dyspepsia is mainly due to a combination of abnormal gastric accommodation and visceral hypersensitivity. In practice, the presence of regular nausea and vomiting/regurgitation of undigested food would point towards a diagnosis of gastroparesis.
The second condition is rumination syndrome, which causes effortless regurgitation, mainly postprandially. This is a behavioural phenomenon caused by subconscious abdominal contractions that cause the regurgitation of food back into the oesophagus. It can be associated with dyspeptic symptoms and in some patients, the rumination behaviour develops as a response to the dyspepsia because it often relieves this sensation. Typical symptoms of rumination syndrome include a cycle of regurgitation followed by swallowing of the regurgitant during or after meals, with this continuing until the regurgitant becomes acidic and is then expelled orally. Rumination syndrome can be diagnosed using combined high-resolution manometry–impedance monitoring, as this can reveal a typical pattern of low-pressure gastric straining followed by regurgitation (figure 3). Patients often complain that they vomit after eating; however, if a thorough history is taken, it can become clear that the vomiting is effortless (i.e. regurgitation). The treatment for this involves education and deep-breathing exercises.
Third are cyclical vomiting and cannabinoid hyperemesis syndromes, which cause episodic attacks of vomiting that usually last for a few days and can be associated with dehydration and electrolyte imbalance. In between episodes, patients are completely asymptomatic, which is not the case for patients with gastroparesis. Cyclical vomiting is very strongly associated with a personal or family history of migraines and cannabinoid hyperemesis syndrome is associated with heavy cannabis intake and the use of hot showers to relieve the nausea. Both of these syndromes can be associated with a delay in gastric emptying.
Eating disorders, such as anorexia nervosa and bulimia nervosa, are the fourth conditions to consider because a low body mass index is associated with delays in gastric emptying and disturbed gastric functioning. It is therefore important to look for a history of eating disorders because the treatment for such disorders involves psychological therapy and enforced nutrition, not, for example, the use of prokinetics.
Fifth are stress and anxiety, which can centrally induce nausea and vomiting. If the anxiety is directed towards food, so-called ‘avoidant restrictive food intake disorder’,5 this condition might present more like gastroparesis, with immediate postprandial nausea and vomiting. Patients may complain that they only have to see food or put it in their mouth for vomiting to occur. This very early response to food, before the food even reaches the stomach, should point more towards psychological causes. In patients who have headaches or new neurological symptoms, it is important to perform a neurological examination, and cross-sectional imaging of the brain may be warranted to exclude a central lesion. Vomiting that is induced by anxiety and stress is best managed with psychotherapy (e.g. cognitive behavioural therapy or mindfulness) or pharmacological therapies (e.g. selective serotonin reuptake inhibitors).
The final condition to consider is narcotic bowel syndrome (also known as opiate-induced central sensitisation syndrome), which is caused by the side effects of opiates on the gut. Typically, patients have worsening abdominal pain, but they can also have nausea, vomiting and epigastric bloating, which are symptoms similar to that of gastroparesis. As gastric emptying is delayed by opiates, it is useful to reassess symptoms and gastric emptying in patients once they have been weaned off them (see mistake 6).
FAQs
Avoid highly acidic, spicy, or roughage-heavy foods that are harder for the stomach to digest that may lead to heartburn or regurgitation symptoms. Supplement dietary intake with high-calorie, liquid-based meals. Remain upright after eating for at least three hours and avoid immediately lying down after a meal.
What aggravates gastroparesis? ›
What to Avoid
- Raw and dried fruits (such as apples, berries, coconuts, figs, oranges, and persimmons)
- Raw vegetables (such as Brussels sprouts, corn, green beans, lettuce, potato skins, and sauerkraut)
- Whole-grain cereal.
- Nuts and seeds (including chunky nut butters and popcorn)
These medications include metoclopramide (Reglan) and erythromycin. Metoclopramide has a risk of serious side effects. Erythromycin may lose its effectiveness over time, and can cause side effects, such as diarrhea. A newer medication, domperidone, with fewer side effects, is also available with restricted access.
What can be mistaken for gastroparesis? ›
Because the condition is relatively unknown, gastroparesis can be mistaken for other types of GI disorders like GERD. Many symptoms of gastroparesis mirror symptoms of GERD. Both disorders may be accompanied by abdominal pain, indigestion and a sensation of fullness, so they are easily confused for one another.
Can you stop the progression of gastroparesis? ›
Gastroparesis is a chronic condition, and in most cases, it does not go away or have a definitive cure. However, its symptoms can be managed, and the progression of the condition can be slowed with appropriate treatment.
How do you calm a gastroparesis flare up? ›
Prokinetics, medications that stimulate gastrointestinal motility, are the first-line treatment for gastroparesis. Prokinetics include: Metoclopramide. This is the only FDA-approved medication to treat gastroparesis.
What is the number one cause of gastroparesis? ›
Diabetes is the most common known underlying cause of gastroparesis. Diabetes can damage nerves, such as the vagus nerve and nerves and special cells, called pacemaker cells, in the wall of the stomach. The vagus nerve controls the muscles of the stomach and small intestine.
Does drinking more water help gastroparesis? ›
Dehydration can increase symptoms of nausea. Sip liquids steadily throughout the day; don't gulp. For most adults, fluid needs are 6-10 cups or 1500-2400 ml per day.
What is the new treatment for gastroparesis? ›
“Tradipitant, if approved, will be the first novel drug for patients with gastroparesis since 1979.
What is the best home treatment for gastroparesis? ›
Home remedies for nausea or abdominal pain
Eating a small piece of fresh ginger or drinking a cup of ginger tea may help relieve symptoms. Drinking peppermint or chamomile tea may also be beneficial. Placing a heating pad on the abdomen or taking a warm bath may also help reduce the pain associated with gastroparesis.
Gastroparesis patients have a high rate of slow transit constipation by radiopaque marker studies than patients with symptoms of gastroparesis with normal gastric emptying (4). Fourth, perhaps constipation and delayed colonic transit could be the primary problem with a secondary delay in gastric emptying.
How did I cured my gastroparesis? ›
How do doctors treat gastroparesis?
- eat foods low in fat and fiber.
- eat five or six small, nutritious meals a day instead of two or three large meals.
- chew your food thoroughly.
- eat soft, well-cooked foods.
- avoid carbonated, or fizzy, beverages.
- avoid alcohol.
In most cases, gastroparesis is a long-term (chronic) condition. You are more likely to have it if you have type 1 or type 2 diabetes. Symptoms may include upset stomach or nausea, vomiting, losing weight, feeling full too soon when eating, belly or abdominal pain or bloating, and heartburn.
How did I cured my gastroparesis naturally? ›
Fast facts on gastroparesis
Complications include dehydration and malnutrition. Natural remedies include eating small, frequent meals and avoiding foods that lead to bloating. Treatment can help relieve symptoms, but the options available will also depend on any underlying condition.
Has anyone ever recovered from gastroparesis? ›
There's no cure for gastroparesis. It's a chronic, long-term condition that can't be reversed. But while there isn't a cure, your doctor can come up with a plan to help you manage symptoms and reduce the likelihood of serious complications.
What is end of life gastroparesis? ›
Read about other symptoms at the end of life
This is called delayed gastric emptying or gastroparesis. Having surgery for pancreatic cancer or having diabetes can also cause the stomach to empty slowly. Symptoms that your stomach is emptying slowly include: feeling and being sick.
What causes gastroparesis flare-ups? ›
Infection, usually from a virus. Certain medications that slow the rate of stomach emptying, such as narcotic pain medications. Scleroderma — a connective tissue disease. Nervous system diseases, such as Parkinson's disease or multiple sclerosis.
What causes gastroparesis to get worse? ›
High blood glucose levels may slow stomach emptying and worsen symptoms. Maintaining good control of blood glucose levels may reduce symptoms.
What medications make gastroparesis worse? ›
Certain medications, such as some antidepressants, opioid pain relievers, and high blood pressure and allergy medications, can lead to slow gastric emptying and cause similar symptoms. For people who already have gastroparesis, these medications may make their condition worse.
Where do you hurt with gastroparesis? ›
Abdominal pain is common in patients with Gp, both IG and DG. Severe/very severe upper abdominal pain occurred in 34% of Gp patients and associated with other Gp symptoms, somatization, and opiate medication use.
