At Johns Hopkins, we believe in a whole-body approach to treating gastroparesis. Our unique, integrative center offers alternative therapies in combination with more traditional treatments.
Gastroparesis Diagnosis Key to Treatment
An accurate diagnosis is necessary to treating gastroparesis, since the treatment depends on the cause. If your doctor diagnosed an underlying disease or condition that is causing the gastroparesis, the treatment will focus on correcting or reversing that condition; if there is no underlying cause, or if it is not possible to treat it, then the goal of treatment is to promote gastric emptying and relieve your symptoms.
The first step is to stop taking medications that inhibit or delay gastric emptying.
Gastroparesis treatment options include:
Many patients who suffer from gastroparesis are not absorbing enough nutrition. Dietary changes can relieve symptoms while maintaining proper nutrition. Dietary modifications include:
Switching to a liquid diet, as liquids empty more easily from the stomach
Eating several small meals throughout the day rather than two or three large meals
Eating foods that are low in fiber and fat; both fiber and fat can cause a delay in gastric emptying
Avoiding hyperglycemia (high blood sugar), which can delay gastric emptying
A trained nutritionist can help you manage your diet.
There are a number of medications available to treat gastroparesis. Your doctor will discuss with you the benefits and risks of each one before deciding on a medication regimen.
Prokinetic medications are drugs that promote gastric emptying and are an important part of managing gastroparesis. Two commonly used medications are:
Erythromycin : This medicine induces forceful contractions, stimulating gastric emptying of both solid and liquid foods. You can take this medicine orally or receive it intravenously. Erythromycin may cause abdominal cramps and nausea.
Metoclopramide : This medicine increases the movements in your digestive system, helping the food to pass through more quickly and efficiently. This is the only medication in the U.S. that is FDA-approved to treat gastroparesis. However, in some patients it may cause movement disorders. Your doctor will discuss with you if you are a candidate for this medication.
Occasionally, prokinetic medication does not offer substantial relief from the nausea and vomiting that are symptoms of gastroparesis. Your doctor may prescribe anti-emetic therapy to help with those symptoms. Anti-emetic drugs are also known as anti-sickness drugs.
If dietary changes and medication did not improve your symptoms, your doctor may perform an endoscopic procedure.
Decompressive gastrostomy . During an endoscopy, your doctor places a gastrostomy tube into your stomach. The tube helps drain the stomach, improving the nausea and vomiting.
Jejunostomy . If the gastrostomy tube is not effective, a jejunostomy tube will be left in place to ensure you remain properly hydrated and nourished. During a jejunostomy, a feeding tube is inserted through your abdomen and into your small intestine. This way, your small intestine receives the nutrients directly, bypassing the stomach.
Doctors at Johns Hopkins are at the forefront of novel therapies for patients with gastroparesis. In fact, we are the only care center in Maryland to offer gastric pacing, a new approach to treating gastroparesis.
Gastric pacing is also known as gastric electric stimulation.
During gastric pacing:
You undergo a small operation to place electrodes on the gastric serosa, the membrane lining of the stomach.
The electrodes provide electric stimulation, either continuously or at certain times, like mealtimes.
The stimulation increases muscle contraction and improves gastric emptying.
Gastric pacing has been shown to decrease nausea in a subset of patients; however, data is still emerging and not all patients benefit. Talk to your Johns Hopkins gastroenterologist to see if gastric pacing is right for you.
Botulinum Toxin (Botox)
In some patients with gastroparesis, spasms of the lower stomach may contribute to abnormal gastric emptying. The contraction and relaxation functions of the stomach are uncoordinated and ineffective. Botulinum toxin is a medicine that your doctor injects into your stomach muscle to prevent muscle contraction. It can help improve spasms in the stomach muscles.
Studies show that the medicine decreases resistance in the muscles and improves gastric emptying. This medicine may be used for select patients with signs of lower stomach spasms; however, it is not used routinely.
Novel Medication Therapies
Research is continuing into certain medications that may be effective for treating gastroparesis. These include medications to affect the movement of the stomach muscles and to improve gastric emptying.
There is anecdotal data to support use of alternative therapies like ginger, herbal therapies, magnetic anti-nausea bracelets and acupuncture. While data is limited, it appears that many patients may benefit from these interventions. Hopkins offers our patients alternative therapies, and we have two trained acupuncturists on staff.