What Does Gastroparesis Feel Like?

Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. It often occurs in people with type 1 diabetes or type 2 diabetes. Though there is no cure for gastroparesis, symptoms can be managed using a combination of medications, surgical procedures, and dietary changes.

This article discusses the symptoms and potential causes of gastroparesis. It also covers how the condition is diagnosed and potential treatment options.

Woman lying on couch with stomach pain
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What Causes Gastroparesis?

Gastroparesis happens when nerves in the stomach are damaged or stop working. The vagus nerve controls the movement of food through the digestive tract. If the vagus nerve is damaged, the muscles of the stomach and intestines do not work normally, and the movement of food is slowed or stopped.

Gastroparesis is most often caused by:

Signs and Symptoms

These symptoms may be mild or severe, depending on the person:

  • Heartburn
  • Nausea
  • Vomiting of undigested food
  • An early feeling of fullness when eating
  • Weight loss
  • Abdominal bloating
  • Erratic blood glucose levels
  • Lack of appetite
  • Gastroesophageal reflux (GERD)
  • Spasms of the stomach wall

Diagnostic Tests

The diagnosis of gastroparesis is confirmed through one or more of the following tests:

  • Barium X-ray: After fasting for 12 hours, you'll drink a thick liquid called barium, which coats the inside of the stomach, making it show up on the X-ray. Normally, the stomach will be empty of all food after 12 hours of fasting. If the X-ray shows food in the stomach, gastroparesis is likely. Radioisotope gastric-emptying scan: This test involves eating food that contains a small amount of radioactive substance so a healthcare provider can see how quickly it leaves the stomach.
  • Gastric manometry: This test measures the stomach's electrical and muscular activity as it digests liquids and solid food. The measurements show how the stomach is working and whether there is any delay in digestion.
  • Wireless motility capsule: Also called a SmartPill, this involves swallowing a capsule that continuously measures and records pH, pressure, temperature, and transit time as it passes through the GI tract.
  • Gastric emptying breath test: For this test, you will eat or drink something containing a specific protein, which can be measured in your breath as it is digested. Breath samples measured for up to four hours help show how fast the stomach has emptied.
  • Blood tests: The practitioner may also order laboratory tests to check blood counts and to measure chemical and electrolyte levels.

To rule out the causes of gastroparesis other than diabetes, the medical professional may do an upper endoscopy or an ultrasound.

  • Upper endoscopy: Through the endoscope, the healthcare provider can look at the lining of the stomach to check for any abnormalities.
  • Ultrasound: This procedure can be used to rule out gallbladder disease or pancreatitis as a source of the problem.

Complications

If food lingers too long in the stomach, it can cause problems like bacterial overgrowth from the fermentation of food. Also, the food can harden into solid masses, called bezoars, that may cause nausea, vomiting, and obstruction in the stomach. Bezoars can be dangerous if they block the passage of food into the small intestine.

Gastroparesis can also make diabetes worse by adding to the difficulty of controlling blood glucose. When food that has been delayed in the stomach finally enters the small intestine and is absorbed, blood glucose levels rise. Since gastroparesis makes stomach emptying unpredictable, a person's blood glucose levels can be erratic and difficult to control.

How to Treat Gastroparesis

The primary treatment goal for gastroparesis related to diabetes is to regain control of blood glucose levels. Treatments include insulin, oral medications, changes in what and when you eat, and, in severe cases, feeding tubes and intravenous feeding.

It is important to note that in most cases treatment does not cure gastroparesis—it is usually a chronic condition. Treatment helps you manage the condition so that you can be as healthy and comfortable as possible.

Insulin for Blood Glucose Control

If you have gastroparesis, your food is being absorbed more slowly and at unpredictable times. To control blood glucose, you may need to:

  • Take insulin more often
  • Take your insulin after you eat instead of before
  • Check your blood glucose levels frequently after you eat and administer insulin whenever necessary

Your healthcare provider will give you specific instructions based on your particular needs.

Medication

Several drugs are used to treat gastroparesis. Your healthcare provider may try different drugs or combinations of drugs to find the most effective treatment, including:

  • Reglan (metoclopramide): This drug stimulates stomach muscle contractions to help empty food. It also helps reduce nausea and vomiting. Metoclopramide is taken 20 to 30 minutes before meals and at bedtime. It should not be used continuously for more than 12 weeks. Side effects of this drug include fatigue, sleepiness, and sometimes depression, anxiety, and problems with physical movement (tardive dyskinesia). The risk of developing tardive dyskinesia increases with duration of treatment and total cumulative dose.
  • Erythromycin: This antibiotic also improves stomach emptying. It works by increasing the contractions that move food through the stomach. Side effects include nausea, vomiting, and abdominal cramps.
  • Domperidone: The U.S. Food and Drug Administration is reviewing domperidone, which has been used elsewhere in the world to treat gastroparesis. It is a promotility agent similar to metoclopramide. It also helps with nausea.
  • Other medications: Other medications may be used to treat symptoms and problems related to gastroparesis. For example, an antiemetic can help with nausea and vomiting. Antibiotics will clear up a bacterial infection. If you have a bezoar, the healthcare provider may use an endoscope to inject medication that will dissolve it.

Dietary Changes

Changing your eating habits can help control gastroparesis. Your practitioner or dietitian will give you specific instructions, but you may be asked to eat six small meals a day instead of three large ones. If less food enters the stomach each time you eat, it may not become overly full.

Also, your healthcare provider or dietitian may suggest that you try several liquid meals a day until your blood glucose levels are stable and the gastroparesis is corrected. Liquid meals provide all the nutrients found in solid foods, but can pass through the stomach more easily and quickly.

In addition, your healthcare provider may recommend that you avoid high-fat and high-fiber foods. Fat naturally slows digestion—a problem you do not need if you have gastroparesis—and fiber is difficult to digest. Some high-fiber foods, like oranges and broccoli, contain material that cannot be digested. Avoid these foods because the indigestible part will remain in your stomach too long and possibly form bezoars.

Feeding Tube

If your condition is severe and other approaches do not work, you may need surgery to insert a temporary feeding tube. The tube, called a jejunostomy tube, is inserted through the skin on your abdomen into the small intestine. It lets you put nutrients directly into the small intestine, bypassing the stomach. You will receive special liquid food to use with the tube.

A jejunostomy is particularly useful when gastroparesis prevents the nutrients and medication necessary to regulate blood glucose levels from reaching the bloodstream. By avoiding the source of the problem—the stomach—and putting nutrients and medication directly into the small intestine, you ensure that these products are digested and delivered to your bloodstream quickly.

Parenteral Nutrition

Parenteral nutrition refers to delivering nutrients directly into the bloodstream, bypassing the digestive system. Your healthcare provider will place a thin tube, called a catheter, in a chest vein, leaving an opening to it outside the skin.

For feeding, you attach a bag containing liquid nutrients or medication to the catheter. The fluid enters your bloodstream through the vein. Your practitioner will tell you what type of liquid nutrition to use.

This approach is an alternative to the jejunostomy tube and is usually a temporary method to get you through a difficult spell of gastroparesis. Parenteral nutrition is used only when gastroparesis is severe and is not helped by other methods.

Other Options

A gastric neurostimulator ("pacemaker") has been developed to assist people with gastroparesis. The pacemaker is a battery-operated electronic device that is surgically implanted. It emits mild electrical pulses that stimulate stomach contractions so food is digested and moved from the stomach into the intestines. The electrical stimulation also helps control nausea and vomiting associated with gastroparesis.

Botox (botulinum toxin) injected into the pyloric sphincter showed promise as a potential gastroparesis treatment. However, the American College of Gastroenterology does not recommend botox for gastroparesis as studies have not found it effective.

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Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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By Sharon Gillson
 Sharon Gillson is a writer living with and covering GERD and other digestive issues.