Treatment Overview
For individuals living with gastroparesis, sitting down to a meal can be a source of anxiety rather than enjoyment. The condition, defined by a delayed emptying of the stomach, often leads to persistent nausea, feeling full after only a few bites, and uncomfortable bloating. These symptoms can make maintaining a healthy weight and getting adequate nutrition a daily struggle. Beyond the physical discomfort, the unpredictability of flare-ups can disrupt work, social gatherings, and general quality of life.
Treatment is essential to restart the digestive process and manage debilitating symptoms. By improving how the stomach empties, patients can alleviate nausea, prevent severe dehydration, and stabilize blood sugar levels, which is particularly critical for those whose condition is caused by diabetes. Because gastroparesis ranges from mild to severe, treatment plans are highly customized. Decisions are often based on the underlying cause such as diabetes or post-surgical complications and how well the patient tolerates different therapies (National Institute of Diabetes and Digestive and Kidney Diseases, 2018).
Overview of treatment options for Gastroparesis
The management of gastroparesis focuses on two main goals: stimulating the stomach muscles to move food into the small intestine and controlling the nausea and vomiting that accompany the delay. While dietary changes such as eating small, low-fiber meals are the foundation of management, medications are almost always necessary for moderate to severe cases.
Pharmacological treatment is typically divided into drugs that promote motility (prokinetics) and drugs that suppress nausea (antiemetics). In severe cases where medications fail to provide relief, doctors may consider procedures like gastric electrical stimulation or placing feeding tubes, but medication remains the primary medical intervention for the majority of patients.
Medications used for Gastroparesis
The most commonly prescribed medication for stimulating stomach contractions is metoclopramide. It is currently the only drug approved by the FDA specifically for treating gastroparesis. It is generally used as a first-line treatment to improve gastric emptying and reduce vomiting.
If metoclopramide is ineffective or not well-tolerated, doctors often prescribe erythromycin. Although erythromycin is an antibiotic, it is widely used in this context because it has a powerful side effect of triggering stomach contractions. Clinical experience suggests that erythromycin is often used for short periods because the body can develop a tolerance to it over time, making it less effective.
To manage the symptom of nausea regardless of stomach movement, antiemetics are frequently prescribed. Common examples include ondansetron and prochlorperazine. These do not speed up digestion but provide essential relief from the urge to vomit. In some cases, domperidone is sought; while not standardly marketed in the U.S., it is available under special FDA programs for patients who cannot take metoclopramide (American College of Gastroenterology, 2022).
How these medications work
Prokinetics like metoclopramide work by blocking dopamine receptors in the gut and tightening the muscles at the entry of the stomach while relaxing the exit valve. This coordination forces food to move downward into the intestines. Erythromycin works differently by mimicking a natural hormone called motilin. It binds to receptors in the stomach and small intestine, causing strong muscle contractions that physically push food forward.
Antiemetics work primarily on the brain and the nervous system. They block the chemical signals such as serotonin or dopamine that the stomach sends to the brain’s “vomiting center.” By interrupting this communication loop, the sensation of nausea is dampened, allowing the patient to eat and drink more comfortably (Mayo Clinic, 2023).
Side effects and safety considerations
Metoclopramide poses a significant risk of neurological side effects, most seriously permanent tardive dyskinesia (involuntary movements). Due to this, short-term use (under 12 weeks) is recommended, and patients should stop the drug immediately if twitching or uncontrolled movements occur.
Erythromycin can cause stomach issues (cramps, nausea, diarrhea). Both erythromycin and domperidone can cause QT prolongation (affecting heart rhythm), requiring an ECG before use in patients with cardiac conditions. Ondansetron can cause constipation and headaches. It is crucial to review all current medications with a healthcare provider to prevent dangerous interactions.
Since everyone’s experience with the condition and its treatments can vary, working closely with a qualified healthcare provider helps ensure safe and effective care.
References
- American College of Gastroenterology. https://gi.org
- Food and Drug Administration. https://www.fda.gov
- Mayo Clinic. https://www.mayoclinic.org
- National Institute of Diabetes and Digestive and Kidney Diseases. https://www.niddk.nih.gov
Medications for Gastroparesis
These are drugs that have been approved by the US Food and Drug Administration (FDA), meaning they have been determined to be safe and effective for use in Gastroparesis.