Gastroparesis

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What is Gastroparesis?

Gastroparesis is a condition where the stomach muscles don't work properly, slowing down or stopping the movement of food. It can be caused by:

  • Diabetes

  • Post-surgical nerve damage

  • Medications

  • Unknown reasons (idiopathic)

Common symptoms include:

  • Nausea and vomiting

  • Feeling full quickly when eating

  • Bloating or upper abdominal discomfort

  • Poor appetite and weight loss

How is Gastroparesis Treated?

Treat underlying or contributing causes

  • Improve control of chronic conditions (e.g., diabetes).

  • Review and stop medications that slow gastric emptying if possible (opioids, certain antidepressants, calcium channel blockers, anticholinergics).

  • Treat autoimmune, infectious, or metabolic causes when identified.

  • Lifestyle and dietary measures:

  • Eat smaller, more frequent meals (4–6 per day).

  • Choose low-fat, low-fiber foods that are easier to digest.

  • Favor liquids and pureed foods if solid foods are poorly tolerated.

  • Chew food thoroughly.

  • Sit upright for 1–2 hours after eating and consider light physical activity after meals.

  • For severe cases, consider nutrition support (enteral feeding via jejunostomy) or, rarely, parenteral nutrition.

Medications:

  • Some medication (called prokinetics) may to improve gastric emptying:

    • Metoclopramide: dopamine antagonist; can reduce nausea and improve motility. Risk of tardive dyskinesia with long-term use—use lowest effective dose and monitor.

    • Domperidone (where available): similar benefit with lower central nervous system side effects; may require special access in some regions.

    • Erythromycin (low-dose, short-term): motilin receptor agonist; effectiveness may wane due to tachyphylaxis.

  • Antiemetics for nausea and vomiting (ondansetron, promethazine, prochlorperazine) as needed for symptom control.

  • Glycemic control in diabetic gastroparesis: optimize blood glucose to improve symptoms and gastric emptying.

Endoscopic therapies

  • Endoscopic balloon dilation of the pylorus: occasionally used in selected cases.

  • Botulinum toxin injection into the pylorus: temporary benefit for some patients; evidence is mixed and effects are often short-lived.

  • Gastric peroral endoscopic pyloromyotomy (G-POEM): endoscopic cutting of the pyloric muscle to improve emptying; considered for refractory gastroparesis, with growing evidence of benefit in selected patients.

Why is G-POEM recommended?

G-POEM is recommended when:

  • Medications and dietary changes haven’t worked

  • You have moderate to severe symptoms affecting quality of life

  • Tests (such as gastric emptying studies) confirm delayed stomach emptying

It’s a less invasive option than traditional surgery and can provide long-term symptom relief.

How is the procedure performed?

  • The procedure is done under general anaesthesia.

  • A flexible tube (gastroscope) is passed through your mouth into the stomach.

  • A tunnel is made under the stomach lining to reach the pyloric muscle.

  • The muscle is cut (myotomy) to allow food to pass more easily.

  • The tunnel is closed with small clips, which fall off on their own.

There are no external cuts or scars.

What are the benefits?

  • Minimally invasive

  • Improves stomach emptying

  • Reduces symptoms like nausea, vomiting, and bloating

  • Shorter recovery compared to traditional surgery

  • May reduce the need for long-term medications or feeding tubes

What are the risks?

While G-POEM is generally safe, possible risks include:

Bleeding: Usually minor and controlled during the procedure

Perforation: Rare, may require additional treatment or surgery

Infection: Antibiotics are given to reduce this risk

Reflux or indigestion: May occur after the procedure

No symptom improvement: In some cases, symptoms may persist or return

What happens after the procedure?

  • Most patients stay in hospital for 1 day.

  • You’ll start on clear fluids, then move to a soft diet, and eventually return to normal food over 1–2 weeks.

  • You’ll be monitored for complications and to ensure your stomach is emptying better.

Long-term care and follow-up

  • You’ll have regular follow-up with your doctor.

  • Some patients may need repeat testing or further treatment.

  • You may still need dietary advice or medications depending on your symptoms.

Frequently Asked Questions

Q: Will G-POEM cure gastroparesis?
A: It does not cure the underlying condition but can greatly improve symptoms in many patients.

Q: Is the procedure painful?
A: No, it is done under general anesthesia. Mild bloating or discomfort may be felt afterwards.

Q: How successful is G-POEM?
A: Studies show up to 60% symptom improvement.

Q: Can I eat normally afterward?
A: You’ll follow a special diet for a few weeks, gradually returning to normal eating.

Surgical interventions

  • Pyloroplasty or pyloromyotomy (open or laparoscopic): surgical widening or cutting of the pylorus to facilitate gastric emptying; considered when other treatments fail.

  • Gastric electrical stimulation (implantable gastric pacemaker): may reduce nausea and vomiting in refractory cases, particularly diabetic gastroparesis; benefit for emptying is variable.

  • Feeding jejunostomy or gastrostomy with jejunal extension for long-term enteral nutrition when oral intake is insufficient.

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