Conditions & Treatments

Gastroparesis

Gastroparesis is a stomach disorder in which the stomach takes too long in emptying its contents.

Gastroparesis

Illustration of the anatomy of the digestive system, adult
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What is gastroparesis?

Gastroparesis is a stomach disorder in which the stomach takes too long in emptying its contents. If food remains in the stomach for too long, it can cause problems such as bacterial overgrowth from the fermentation of the food. The food can also harden into solid masses, called bezoars, that may cause nausea, vomiting, and, sometimes, obstruction in the stomach. This can be dangerous if they block the passage of food into the small intestine.

What causes gastroparesis?

Most often, this condition is a complication of type 1 diabetes. It can also occur in persons with type 2 diabetes, although not as frequently. Gastroparesis is caused when the vagus nerve, which controls the movement of food through the digestive tract, is damaged or stops working. When this happens, the movement of food is slowed down or stopped.

The vagus nerve becomes damaged in persons with diabetes when blood glucose (sugar) levels remain high over a long period of time.

Other causes of gastroparesis include the following:

  • Anorexia nervosa

  • Surgery on the stomach or vagus nerve

  • Postviral syndromes

  • Certain medications, particularly those that slow contractions in the intestine

  • Disorders involving smooth muscle, such as amyloidosis and scleroderma

  • Diseases of the nervous system, such as abdominal migraine and Parkinson's disease

  • Metabolic disorders, including hypothyroidism

What are the symptoms of gastroparesis?

The following are the most common symptoms of gastroparesis. However, each individual may experience symptoms differently. Symptoms may include:

  • Nausea

  • Vomiting

  • Weight loss

  • Feeling full early when eating

  • Abdominal bloating and/or discomfort (epigastric pain)

  • Heartburn

The symptoms of gastroparesis may resemble other medical conditions or problems. Always consult your doctor for a diagnosis.

How is gastroparesis diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for gastroparesis may include the following:

  • Blood tests.  These tests check blood counts and measure chemical and electrolyte levels.

  • Upper GI (gastrointestinal) series (also called barium swallow). A diagnostic test that examines the organs of the upper part of the digestive system: the esophagus, stomach, and duodenum (the first section of the small intestine). A fluid called barium (a metallic, chemical, chalky, liquid used to coat the inside of organs so that they will show up on an X-ray) is swallowed. X-rays are then taken to evaluate the digestive organs.

  • Barium beefsteak meal. During this test, the patient eats a meal containing barium, allowing the radiologist to watch the stomach as it digests the meal. The amount of time it takes for the barium meal to be digested and leave the stomach gives the doctor an idea of how well the stomach is working and helps to detect emptying problems that may not show up on the liquid barium X-ray.

  • Radioisotope gastric-emptying scan. During this test, the patient eats food containing a radioisotope, which is a slightly radioactive substance that will show up on a scan. The dosage of radiation from the radioisotope is very small and not harmful, but allows the radiologist to see the food in the stomach and how quickly it leaves the stomach, while the patient lies under a machine.

  • Gastric manometry. This test measures electrical and muscular activity in the stomach. The doctor passes a thin tube down the patient's throat into the stomach. This tube contains a wire that takes measurements of the electrical and muscular activity of the stomach as it digests foods and liquids. This helps show how the stomach is working, and if there is any delay in digestion.

  • Esophagogastroduodenoscopy (also called EGD or upper endoscopy). This is a procedure that allows the doctor to examine the inside of the esophagus, stomach, and duodenum. A thin, flexible, lighted tube, called an endoscope, is guided into the mouth and throat, then into the esophagus, stomach, and duodenum. The endoscope allows the doctor to view the inside of this area of the body, as well as to allow instruments through the scope for the removal of a sample of tissue for biopsy (if necessary).

  • Scintigraphic gastric accommodation. During this test, the volume of stomach contents before and after a meal are measured, and how well the stomach relaxes in response to food intake.

Sometimes, in an effort to rule out other digestive conditions, an endoscopy and ultrasound may be performed.

Treatment for gastroparesis

Specific treatment for gastroparesis will be determined by your doctor based on:

  • Your age, overall health, and medical history

  • Extent of the condition

  • Your tolerance of specific medicines, procedures, or therapies

  • Expectations for the course of the condition

  • Your opinion or preference

Gastroparesis is usually a chronic condition, so treatment does not cure it, but rather helps the patient manage the condition. In gastroparesis related to diabetes, the primary goal is to regain control of the blood glucose levels.

Treatment may include:

  • Medications. Several medications are used to treat gastroparesis. Your physician may prescribe combinations of medications or different medications to determine which is the most effective. Botulinum toxin has also been shown to improve symptoms when injected directly into the pyloric sphincter.

  • Dietary modifications. Changing eating habits can also help control gastroparesis. Sometimes, eating six smaller meals a day is more effective than eating three larger ones. Some doctors recommend several liquid meals a day until blood glucose levels are stable and gastroparesis is stable. Your doctor may also recommend avoiding fatty and high-fiber foods, as these can slow digestion and be difficult to digest. It is important to consult your doctor or dietitian for the best eating plan for your condition. Botulinum toxin has also been shown to improve symptoms when injected directly into the pyloric sphincter.

  • Surgery. Occasionally, when other approaches fail, it is necessary to perform a surgical procedure called jejunostomy, in which a feeding tube is inserted through the skin on the abdomen into the small intestine. This tube then allows nutrients to be put directly into the small intestine, bypassing the stomach. This is used only when gastroparesis is severe and prevents the nutrients and medications necessary to regulate blood glucose levels from reaching the bloodstream.

    A new surgically implanted device, known as a "gastric neurotransmitter," may also be used to control nausea and vomiting.

  • Parenteral nutrition. An alternative to the jejunostomy tube is parenteral nutrition, in which nutrients are delivered directly into the bloodstream, bypassing the digestive system. The doctor places a catheter in a chest vein, leaving an opening on the outside of the skin. A bag with liquid nutrients or medication can be attached to the catheter, allowing the fluid to enter the bloodstream through the vein.

Treatment Programs


Massachusetts General Hospital understands that a variety of factors influence patients' health care decisions. That's just one reason why we're dedicated to ensuring patients understand their diagnosis and treatment options. Because a single option might not serve all patients, we offer a wide range of coordinated treatments and related services across the hospital. Patients should consult with their primary care doctor or other qualified health care provider for medical advice and diagnosis information.

Select a treatment program for more information:



Digestive Healthcare Center

  • Weight Center
    The Massachusetts General Hospital Weight Center is a fully integrated center within the Digestive Healthcare Center that supports the spectrum of needs for people of all ages seeking help with obesity and weight loss.
  • Barrett’s Esophagus Treatment Center
    The multidisciplinary Barrett’s Esophagus Treatment Center at Massachusetts General Hospital provides comprehensive care, from endoscopic diagnosis to minimally invasive treatment, for Barrett’s esophagus.
  • Swallowing and Heartburn Center
    The Swallowing and Heartburn Center at the Massachusetts General Hospital Digestive Healthcare Center provides both primary treatment and second opinion evaluations for throat, esophagus and stomach disorders.
Imaging

  • Pediatric Imaging
    The Pediatric Imaging Program at Massachusetts General Hospital Imaging specializes in ensuring the safety and comfort of child patients while providing the latest technology and the expertise of specialized pediatric radiologists.
  • Neuroendovascular Program
    Working as part of the Vascular Center, the interventional specialists of the Neuroendovascular Program perform minimally invasive, image-guided treatments for conditions including stroke and cerebral aneurysm. These same interventionalists also use minimally invasive techniques to treat non-vascular conditions including herniated disc and vertebral fractures. In addition, our specialty-trained radiologists use the latest imaging technologies to provide diagnostic exams for a full range of neurological conditions.
  • Adult Medicine Imaging
    The Adult Medicine Imaging Program at Massachusetts General Hospital Imaging offers a wide range of diagnostic exams and minimally invasive, image-guided treatments, all provided using leading-edge equipment and interpreted by specialty-trained radiologists.
MassGeneral Hospital for Children

  • Pediatric Endocrine Program and Diabetes Center
    The Pediatric Endocrinology Program and Diabetes Center at MassGeneral Hospital for Children is an international referral center for the management of pediatric diabetes and endocrine disorders in children and adolescents.
Gastroenterology

  • Swallowing and Heartburn Program
    The Swallowing and Heartburn Program at the Gastroenterology Division of Massachusetts General Hospital provides both primary treatment and second opinion evaluations for disorders of the esophagus and stomach.

The following related clinical trials and research studies are currently seeking participants at Massachusetts General Hospital. Search for clinical trials and studies in another area of interest.

Innovative care at the Digestive Healthcare Center

Learn more about the latest treatment options for this condition at the Digestive Healthcare Center