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Expert Q&A

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Even on a liquid diet, my stomach won't empty

Asked by Mildred, Maine

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I have severe gastroparesis with a gastric pacemaker and have had no relief. I am now on a full liquid diet and still have many problems. Is there anything else I can do?

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Conditions Expert Dr. Otis Brawley Chief Medical Officer,
American Cancer Society

Expert answer

Gastroparesis is also called gastric stasis or delayed gastric emptying. Food doesn't move through the stomach and small bowel as it should.

People who have this can experience nausea, vomiting, bloating, early and easy satiety, and weight loss.

Some people with gastroparesis actually experience reflux, which is a condition in which food from the stomach travels back up the esophagus and even into the mouth and throat.

Some patients have occasional episodes of it; others have it chronically.

Gastroparesis in either form is most commonly caused by long-term diabetes mellitus. The more chronic form is occasionally seen in multiple sclerosis and is rarely due to some uncommon muscle diseases such as hollow visceral myopathy or progressive systemic sclerosis.

It is usually diagnosed with a nuclear medicine gastric emptying study. In this study, the patient eats a substance that can be imaged as is travels through the bowel.

Gastroparesis must be distinguished from a subacute obstruction of the bowel. Obstruction can cause delayed gastric emptying and the same symptoms of gastroparesis. Obstruction often requires surgical therapy.

The management of gastroparesis requires a gastroenterologist working with a dietitian or nutrition expert. Initial treatment is with dietary modifications.

There can be benefit to frequent small meals and limiting intake of dietary fat and nondigestible fiber, such as fresh fruits and vegetables. Liquids tend to pass through the stomach and small bowel better than solids. Some may have to consume homogenized or liquid meals supplemented with vitamins.

Attention must be paid to adequate hydration, adequate caloric intake and maintenance of body minerals such as potassium and sodium. Long-term mineral and vitamin deficiencies (especially deficiencies of vitamin B12 and Iron) can be a problem. One must also be attentive to blood-sugar levels in those with diabetes.

In an acute episode of gastroparesis, the antibiotic erythromycin can be given by slow intravenous infusion to "kick-start" the stomach. It stimulates contraction of the stomach and stomach emptying.

Other drugs that are often used on a more chronic basis are metoclopramide, domperidone and Cisapride. These drugs all have serious side effects and should be used only when absolutely necessary. Long-term metaclopramide can cause anxiety, depression and neurologic symptoms. Domperidone and Cisapride are commonly used in some countries, but their use is severely restricted in the U.S., as they have significant interactions with a number of commonly used drugs.

Occasionally, severe gastroparesis is treated with liquid feeding through a tube that is surgically placed through the abdominal wall and into the small bowel. This is called a jejunostomy tube. Even more severe gastroparesis is treated with parenteral nutrition, which is a complicated intravenous feeding regimen.

Gastric electrical stimulation with an implantable device is a treatment for which there is very limited clinical trial evidence of efficacy. It is designated as a humanitarian use device that is to be tried only in patients with very severe gastroparesis.

For more detailed information, I would refer you to the the American Gastroenterological Association technical review for gastroparesis.

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