As of Thursday, April 11, 2013
DEAR DOCTOR K: A friend has a condition called gastroparesis. Could you explain what it is and how it can be treated?
DEAR READER: Gastroparesis is the term used for sluggish emptying of food from the stomach into the small intestine. Normally, your stomach moves about half of an average meal into the small intestine within two hours after you eat. Within four hours, about 90 percent of your meal is in the small intestine. If you have gastroparesis, food stays in the stomach much longer.
Common symptoms include nausea and upper abdominal pain. It may become difficult to keep a full meal down. People with serious cases may eat so little they become dangerously thin and malnourished.
Gastroparesis has a number of causes, with diabetes topping the list. Diabetes can damage nerves, including the nerves that control stomach function. That nerve damage slows the speed of emptying. Several medications can also slow stomach emptying. These include antihistamines, tricyclic antidepressants, calcium-channel blockers and opioid painkillers.
Some people develop gastroparesis after recovering from a gastrointestinal viral infection. Neurological diseases such as multiple sclerosis and Parkinson’s disease can also affect how well the stomach does its job.
One of the first things people can do to help control symptoms is to limit — or even avoid — fatty and fiber-rich foods. Fatty foods delay the emptying of the stomach in all of us, and probably do so even more in people with gastroparesis. This appears to be equally true of “good fats” (polyunsaturated and monounsaturated fats) as well as “bad fats” (saturated fats and trans fats). For that reason, people with gastroparesis should focus on eating smaller amounts of fats — primarily the good fats, which our bodies need.
Foods rich in non-digestible fiber (typically fruits and vegetables) also exit the stomach more sluggishly than digestible food. That’s true for all of us. Food that is digested, by stomach acid and other substances, is broken into tiny pieces that more easily leave the stomach. In contrast, non-digestible fiber leaves the stomach only when the stomach muscles push it into the intestine.
Please understand that I’m not advocating that everyone avoid fiber-rich foods — in fact, they’re good for us. They just cause problems in people with gastroparesis.
Gastroparesis can be reduced in diabetics by keeping blood sugar under good control.
Finally, eating frequent small meals rather than three large ones can help.
Unfortunately, there’s no wonder drug for this condition. A drug called metoclopramide (Maxolon, Reglan) can be effective. But doctors don’t like to prescribe it at full dosage or for extended periods because it can cause an often irreversible involuntary movement disorder.
Very low doses of erythromycin, an antibiotic, are often prescribed for gastroparesis. Erythromycin can speed up movement of the stomach. However, its long-term success is mediocre at best.
Gastric pacemakers are devices that stimulate the stomach to contract. They’ve shown some benefit in clinical trials. For most people with gastroparesis, however, the simpler measures I’ve recommended can bring sufficient relief.
Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.