Delayed Gastric Emptying
Gastroparesis is a condition that affects the normal spontaneous movement of the stomach’s muscles. Normally, muscular contractions propel food through your digestive tract, but in gastroparesis, the stomach’s motility is slowed down, preventing the stomach from properly emptying 1. Although the true prevalence of gastroparesis remains unknown, data from the U.S. suggest that it may affect up to 2% of the American population 2. Delayed gastric emptying also poses a problem for those needing procedural anesthesia, as patients need to have an empty stomach before undergoing anesthesia to minimize the risk of vomiting and aspiration. Delayed gastric emptying can be treated with medications to facilitate normal digestion.
The cause of gastroparesis is usually unknown. It is not uncommonly a complication of diabetes, however, and many patients develop gastroparesis following surgery. Women are known to be more likely to suffer from gastroparesis than men 1.
Signs and symptoms of delayed gastric emptying include but are not limited to nausea, vomiting, bloating, acid reflux, changes in blood sugar levels, a lack of appetite, and weight loss or malnutrition. This said, many people with gastroparesis do not even develop any visible signs or symptoms 1.
Changes to one’s diet, along with medications, can offer a certain degree of relief. How doctors treat gastroparesis depends on the cause, how severe the symptoms and complications are, and how well a patient responds to different treatments available.
The initial management of gastroparesis consists of dietary modifications and the optimization of glycemic control and hydration. In patients with persistent symptoms, pharmacologic therapy with prokinetics and antiemetics may be initiated 3. Certain medications however, such as opioid pain relievers, some antidepressants, and allergy and high blood pressure medications, might result in slower gastric emptying. These medications may only worsen the symptoms of gastroparesis in some cases.
A patient’s physician may prescribe medicines that help the stomach’s muscles work better. They may also prescribe medicines to control nausea and vomiting and to reduce pain. To this end, one or more of the following medicines may be prescribed 4.
Metoclopramide increases the contraction of the muscles in the stomach’s wall and may improve gastric emptying. Metoclopramide may also help with the relief of any vomiting or nausea. Domperidone also increases the contraction of the muscles in the stomach’s wall and may improve gastric emptying. However, it remains available for use only under a special program of the U.S. Food and Drug Administration. Erythromycin also increases stomach muscle contraction and might improve gastric emptying.
Antiemetics help relieve nausea and vomiting symptoms that can occur with delayed gastric emptying, and include ondansetron, prochlorperazine, and promethazine. Over the counter antiemetics include bismuth subsalicylate and diphenhydramine. Certain antidepressants, like mirtazapine, may also help with the relief of vomiting and nausea. These medicines may not necessarily improve gastric emptying, however. Pain medicines that are not narcotics may further help to simply reduce abdominal pain resulting from gastroparesis 3.
It is critical to consult your physician in order to obtain the right treatment in the case of any worrying signs or symptoms of delayed gastric emptying. This will ensure the best patient outcomes through a patient-tailored medication regimen.
References
1. Gastroparesis – Diagnosis and treatment – Mayo Clinic. Available at: https://www.mayoclinic.org/diseases-conditions/gastroparesis/diagnosis-treatment/drc-20355792. (Accessed: 3rd June 2023)
2. Parkman, H. P. Idiopathic gastroparesis. Gastroenterology Clinics of North America (2015). doi:10.1016/j.gtc.2014.11.015
3. A New Approach to Managing Gastroparesis. Available at: https://www.uspharmacist.com/article/new-approach-to-managing-gastroparesis. (Accessed: 3rd June 2023)
4. Treatment for Gastroparesis – NIDDK. Available at: https://www.niddk.nih.gov/health-information/digestive-diseases/gastroparesis/treatment. (Accessed: 3rd June 2023)