Treating gastroparesis

Gastroparesis can't usually be cured, but dietary changes and medical treatment can help you control the condition.

Dietary changes

You may find these tips helpful:

• instead of three meals a day, try smaller,more frequent meals this means there's less food in your stomach and it will be easier to pass through your system
• try soft and liquid foods theseare easier to digest
• chew food well before swallowing
• drink non-fizzy liquids with each meal

It may also help to avoid certain foods that are hard to digest such as apples with their skin on, or high-fibre foods like oranges and broccoli as well as foods high in fat, which can also slow down digestion.

Medication

The following medications may be prescribed to help improve your symptoms:

• domperidone which is taken before eating to contract your stomach muscles and help move food along
• erythromycin an antibiotic that also helps contract the stomach and may help move food along
• anti-emetics medication that controls nausea

However, the evidence that these medications relieve the symptoms of gastroparesis is relatively limited and they can cause a number of side effects. Your doctor shoulddiscuss the potential risks and benefits with you.

Domperidone shouldonly be taken at the lowest effective dose for the shortest possible duration because of the small risk of potentially serious heart-related side effects.

Electrical stimulation

If dietary changes and medication don't improve your symptoms, a relatively new treatment called gastroelectrical stimulation may be tried. However, this is currently not routinely funded by many local NHS authorities.

Gastroelectrical stimulation involves surgically implanting a battery-operated device under the skin of your tummy.

Two leads attached to this device are fixed to the muscles of your lower stomach. They deliver electrical impulses to help stimulate the muscles involved in controlling the passage of food through your stomach. The device is turned on using a handheld external control.

The effectiveness of this treatment can vary considerably. Not everyone will respond to it, and for many of those who do the effect will largely wear off within 12 months. This means electrical stimulation isn't suitable for everyone with the condition.

There's also a small chance of this procedure leading to complications that would require removing the device,such as:

• infection
• the device dislodging and moving
• a hole forming in your stomach wall

Speak to your surgeon about the possible risks. You can also read the National Institute for Health and Care Excellence (NICE) guidelines on gastroelectrical stimulation for gastroparesis .

Botulinum toxin

More severe cases of gastroparesis may occasionally be treated by injecting botulinum toxin into the valve between your stomach and small intestine.

This relaxes the valveand keeps it open for a longer period of time so food can pass through.

The injection is given through an endoscope, which is passed down your throat and into your stomach.

This is a fairly new treatment and some studies have found it may not be very effective, so it's not recommended by all doctors.

A feeding tube

If you have extremely severe gastroparesis that isn't improved with dietary changes and medication, you may benefit from a feeding tube.

Many different types of temporary and permanent feeding tube are available.

A temporary feeding tube called a nasojejunal tube may be offered to you first, which is inserted through your nose to pass nutrients directly into your small intestine.

A feeding tube can also be inserted into your bowel surgically through a cut (incision) made in your tummy. This is known as a jejunostomy.

Liquid food containing nutrients can be fed through the tube, which goes straight to your bowel to be absorbed, bypassing your stomach.

Speak to your doctor about the risks and benefits of each type of feeding tube.

An alternative feeding method for severe gastroparesis is intravenous (parenteral) nutrition, where liquid nutrients are passed straight into your bloodstreamthrough a catheterfed into a large vein.

Surgery

Some people may benefit from having an operation to insert a tube into the stomach through the tummy. This tube can be periodically opened to release gas and relieve bloating.

A surgicalprocedure may be recommended as a last resort to either:

• create a new opening between your stomach and small intestine (gastroenterostomy)
• connect your stomach directly to the second part of your small intestine, called the jejunum (gastrojejunostomy)

These procedures may reduce your symptoms by allowing food to move through your stomach more easily.

Your doctor can explain whether any procedures are suitable for you, and can discuss the possible risks involved.