Gastroparesis

Symptoms and causes

Typical symptoms include nausea, vomiting (sometimes of food eaten hours earlier), feeling full after a few bites, bloating, and upper-abdominal discomfort. Severe cases can lead to weight loss, dehydration, and difficulty controlling blood sugar.

Common causes include:

• Diabetes, through damage to the nerves that control the stomach
• Surgery on the esophagus or stomach — including anti-reflux or hiatal hernia operations — which can occasionally affect the vagus nerves
• Medications that slow emptying, such as opioids and GLP-1 receptor agonist medicines used for diabetes and weight loss
• No identifiable cause (idiopathic gastroparesis), sometimes after a viral illness

Why it matters in foregut care

Slow emptying can cause regurgitation and heartburn-like symptoms, and it can make reflux worse. It can also explain bloating and nausea that persist after anti-reflux surgery. When symptoms suggest it, a gastric emptying study is added to the evaluation before or after reflux surgery.

Diagnosis

An upper endoscopy first rules out a blockage or ulcer. A gastric emptying study — eating a light meal containing a small amount of a tracer and having scans over about four hours — then measures emptying. A breath test is an alternative in some settings. Medications that slow emptying are usually stopped beforehand when possible, and blood sugar should be reasonably controlled on the day of the test.

Treatment

Most people start with non-surgical measures:

• Diet: smaller, more frequent meals that are lower in fat and fiber; liquids and pureed foods empty more easily
• Blood-sugar control in people with diabetes
• Medication review, stopping drugs that slow emptying when possible
• Medicines to reduce nausea or improve emptying; metoclopramide, for example, carries a warning about a movement disorder with long-term use, so its use is monitored

For severe symptoms that don’t respond to these measures, procedures may be considered:

• Pyloroplasty — surgically widening the outlet of the stomach, usually laparoscopically. Dr. Speer co-authored a 2016 study of laparoscopic pyloroplasty for refractory gastroparesis (see Research).
• G-POEM (gastric per-oral endoscopic myotomy) — dividing the pyloric muscle from inside with an endoscope. In a small sham-controlled trial, 71% of patients treated with G-POEM met the study’s definition of success at six months, compared with 22% after a sham procedure.
• Gastric electrical stimulation — an implanted device used for selected patients with refractory nausea and vomiting.
• Feeding tubes to support nutrition, and, rarely, partial removal of the stomach in carefully selected situations.

Gastroparesis surgery is among the areas of expertise listed in Dr. Speer’s professional profile, and her training includes pyloroplasty and gastrectomy for gastroparesis.