Gastroparesis, or paralysis of the stomach, is a condition of the digestive system that is commonly associated with diabetes but could result from other factors. With the stomach’s inability to empty food normally, gastroparesis can cause symptoms such as heartburn, nausea, vomiting, and feeling full quickly after eating. Other than long-term diabetes, damage to the nervous system, surgery, or viral infections could also result in gastroparesis.
The gastroparesis community frequently encounters misdiagnosis and insufficient treatment options. Additionally, those with severe symptoms may have a significantly diminished quality of life and may also struggle with access to adequate care.
Diagnosis and Disease Management
Several gastrointestinal conditions present similar symptoms, which can lead to misdiagnosis and mistreatment. Delayed emptying of stomach contents may be a result of an obstruction but can be ruled out by doing an endoscopy. While scintigraphy is a commonly used diagnostic test to measure gastric emptying time, other options include a breath test, a smart pill (wireless motility capsules), high-resolution electrical mapping, and electrogastrography.
Unexplained nausea and vomiting are often diagnosed as gastroparesis. This leads patients to conform to
- dietary adjustment
- treatment with prokinetic or antiemetic agents
- pyloric botulinum toxin injections
- placement of gastrostomy and jejunostomy tubes
- implantation of gastric electrical stimulators, and/or
- surgery
However, treating patients without understanding their health history may lead to unnecessary treatment and hospitalization and have a significant impact on their quality of life.
Ideally, multiple specialists should be involved in disease management: surgeon, gastroenterologist, radiologist, nurse, dietitian, clinical psychologist, and pharmacist.
New Drugs on the Horizon
Symptomatic treatment options for gastroparesis are prokinetic (promotility) and antiemetic agents. While metoclopramide is the only drug FDA-approved for treating gastroparesis, doctors often use drugs off-label—meaning for treating a condition other than what is approved by the FDA—based on their clinical observations. Here’s information on some of these treatment options.
A few new drug treatments are currently under development and bring promise of individualized patient treatment:
- Tradipitant: A selective neurokinin-1 receptor antagonist, this drug has been shown to improve the Gastroparesis Cardinal Symptom Index by >1 point in 46.6% of patients compared to 23.5% patients on placebo. Patients on the drug also did much better with nausea, especially those who had significant baseline nausea and vomiting.
- Relamorelin: A Ghrelin receptor agonist, relamorelin can improve diabetic gastroparesis and reduces core symptoms. Proactive monitoring of blood glucose levels may be required in diabetic patients being treated with this drug.
- Felcisetrag: This 5-HT4 receptor antagonist may be effective in treating acute gastrointestinal motility disorders and for enteral feeding intolerance.
While drug treatments are vital, modifying your diet in consultation with a dietitian is equally important for adequate disease management. Here are some useful resources that can support patients and caregivers: