Changes in diet, medication can relieve gastroparesis

Q: My mother has Type 1 diabetes. She was recently diagnosed with gastroparesis, which gives her severe abdominal pain and leaves her with very little appetite. She is suffering terribly with this disease. Are there special diet changes that would help make the condition more manageable? What are her other treatment options?

A: Gastroparesis is the term used for sluggish emptying of food from the stomach into the small intestine. This condition is not caused by a physical blockage. Instead, the stomach muscles do not contract properly, reducing the stomach's ability to empty its contents. This causes fluid and food to linger far longer than normal.

Gastroparesis can be an extremely troubling complication of diabetes. The chief culprit is damage to the nerves that control flow of food from the stomach into the intestine. Elevated blood glucose levels can also contribute to the problem.

A normal stomach moves about half of an average meal into the small intestine within two hours after you eat. Within four hours, about 90 percent of the meal has been emptied into the small intestine. In a person with gastroparesis, like your mother, food stays in the stomach much longer. Nausea and upper abdominal pain are common symptoms.

It may become difficult to keep a full meal down. People with serious cases may eat so little they become dangerously thin and malnourished.

Although diabetes is the leading cause of gastroparesis, other problems can also interfere with normal stomach function.

A wide variety of medications can slow stomach evacuation, including antihistamines, tricyclic antidepressants, calcium-channel blockers and opioid painkillers (codeine, oxycodone and others).

Some people suffer from gastroparesis after they recover from a gastrointestinal viral infection. Neurological diseases such as multiple sclerosis and Parkinson's disease can also affect how well the stomach does its job.

Treating gastroparesis is a challenge for patients and their doctors.

There's no wonder drug, and surgery is not an answer.

One of the first things people can do is to limit - or even avoid - fatty and fiber-rich foods that are known to linger in the stomach. Eating frequent small meals rather than three large ones is recommended. If diabetes is the presumed cause, then optimal blood sugar control should be a goal.

A number of medications have been used to try to improve gastric emptying. One of them, cisapride (Propulsid), looked promising, but it was pulled off the market over 10 years ago because of cardiac side effects. Domperidone (Motilium), a drug that increases contractions of the small intestine and stomach, is sometimes helpful. But it hasn't been approved for sale in the United States.

Metoclopramide (Maxolon, Reglan) is available in this country and can be effective. However, one serious but rare side effect makes doctors reluctant to prescribe it at full dosage or for extended periods. This possible - but unlikely - side effect is tardive dyskinesia, an involuntary movement disorder that is often irreversible.

Some doctors prescribe very low doses of erythromycin, an antibiotic. Erythromycin can speed up movement of the stomach. However, its long-term success rate is mediocre, at best.

If gastroparesis doesn't respond to medication or dietary changes, and the person is becoming seriously malnourished, other interventions may be necessary. One option is a feeding tube. There are also devices called gastric pacemakers. These devices stimulate the stomach to contract and have shown some benefit in research studies. But they are a last-ditch measure. The same goes for surgical approaches, which are rarely used these days.

There is no fast fix for a sluggish stomach. But with careful attention to detail, your mother may be able to get some relief from gastroparesis.

Dr. Komaroff is a physician and professor at Harvard Medical School. Go to his website to send questions and get additional information: www.AskDoctorK.com.