Gastroparesis caused by damaged nerves
Dear Doctors: Is there a standard treatment for gastroparesis? I have a mild case of it, along with Type 2 diabetes, and I am unsure how to proceed. One of my doctors prescribed erythromycin, but another one said that only changing my diet will help. How do I know who is right?
Dear Reader: Gastroparesis is a condition in which damage to the nerves that activate the stomach muscles causes a delay in digestion. Specifically, it prevents the contents of the stomach from moving into the small intestine in a timely manner. In normal digestion, food spends an hour or two in the stomach, mixing with and being broken down by digestive juices. The resulting slurry, known as chyme, is then moved into the small intestine by a series of wavelike muscle contractions known as peristalsis.
When someone has gastroparesis, the peristaltic action of the stomach muscles is impaired. This makes it difficult for food to leave the stomach. Symptoms of the condition include belching, gas, bloating, nausea, vomiting, loss of appetite, heartburn and pain. This type of stalled digestion sets the stage for the growth of bacteria. In some cases, it leads to the formation of a coagulated mass called a bezoar, which can cause a blockage.
It is estimated that one-third of cases of gastroparesis are linked to diabetes, a disease that can cause nerve damage. It adds to the health risks of people living with diabetes because the digestive delay can impair blood glucose control. Gastroparesis can also be caused by viral stomach infections, surgical injury, an underactive thyroid and certain neurological or autoimmune conditions. Although rare, gastroparesis can arise as a side effect of medications that affect digestion, such as opioids, calcium channel blockers and antihistamines.
The erythromycin that you have been prescribed is sometimes used to stimulate the stomach muscles in gastroparesis and other types of gastric disorders. Although common, this is an off-label use of the antibiotic. Diet is also an important part of managing the condition. People living with gastroparesis are asked to eat small, nutrientdense meals made up of soft, well-cooked foods. High-fat foods, which delay gastric emptying, are to be avoided. So are highly processed foods and those with added sugars, both of which can wreak havoc on glucose control.
Foods that are high in fiber can be difficult to digest. For that reason, patients are asked to limit their use. For many types of foods, cooking can overcome this restriction. A carrot or an apple in raw form would be difficult for someone with gastroparesis to digest. But if the carrot is cooked or the apple presented in the form of applesauce, each can be included in the diet. Because nutrition and glucose control present challenges to people living with gastroparesis, working with a registered dietitian can be beneficial.
When it comes to the mixed treatment messages you are receiving from your doctors, your best bet is to ask them for clarifications. You can also ask them to consult with each other. If their approaches continue to diverge, you may want to seek a new opinion.
Eve Glazier, M.D., MBA, is an internist and associate professor of medicine at UCLA Health. Elizabeth Ko, M.D., is an internist and assistant professor of medicine at UCLA Health.
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