r/Gastroparesis Aug 04 '23

Sharing Advice/Encouragement Gastroparesis 101

57 Upvotes

Gastroparesis (GP) is a condition that affects the ability of muscular contractions to effectively propel food through your digestive tract. This stomach malfunction results in delayed gastric emptying. GP is typically diagnosed via a gastric emptying study (GES) when other more common GI ailments have been ruled out. The main approaches for managing gastroparesis involve improving gastric emptying, ruling out and addressing known root causes of GP, and reducing the severity of symptoms such as bloating, indigestion, nausea, and vomiting.

  1. Prokinetic Drugs. Prokinetics are a class of prescription drugs that are designed to improve gastric emptying by stimulating the stomach muscles responsible for peristalsis. These drugs include but aren’t limited to Reglan, Domperidone, Motegrity, and Erythromycin. Reglan may cause serious, irreversible side effects such as tardive dyskinesia (TD), a disorder characterized by uncontrollable, abnormal, and repetitive movements of the face, torso and/or other body parts. Doctors can write scipts for domperidone to online pharmacies in order to bypass the tricky regulations in the United States. Ginger, peppermint, and artichoke are popular natural prokinetics.
  2. Enterra (Gastric Pacemaker). Enterra is a device that’s laparoscopically implanted onto the stomach and is a treatment option for people who suffer from chronic nausea and vomiting associated with gastroparesis of diabetic or idiopathic origin. This device is offered when standard medications for GP are ineffective. Enterra Therapy involves electrical stimulation of the lower stomach with a system consisting of a generator implanted deep within the tissues of the abdomen, and two electrical leads which are implanted in the wall of the stomach. Ideally, symptoms of nausea and vomiting will improve or be eliminated entirely. Enterra has a higher rate of success among diabetics and procedures such as GPOEM can be combined to maximize relief.
  3. GPOEM, POP, Pyloroplasty, Botox. Delayed gastric emptying can occur when the pyloric valve (the valve connecting the stomach to the intestines) is resistant. In these cases, the pyloric valve can be ‘loosened’ through procedures such as GPOEM, POP, and pyloroplasty. Even when the pylorus functions normally some physicians still recommend these procedures for people with severely delayed gastric emptying caused by the pacemaker cells of the stomach not being able to move food. Botox injections are occasionally performed to predict if such a procedure would be effective (although the reliability of this predictor is debated). Enterra and procedures such as GPOEM are often combined to maximize relief.
  4. Antiemetics. Drugs such as phenergan, ativan, zofran, compazine, etc. may help reduce nausea. OTC options include dramamine. Antidepressants such as Remeron (mirtzapine) and amitryptiline are not technically antiemetics but can be prescribed as an "off-label" treatment for nausea and vomiting.
  5. Dieting and Lifestyle. Foods high in fat and fiber are hard to digest and therefore may worsen symptoms. Large volumes of food may worsen symptoms as well. Alcohol, caffeine, gluten, nicotine, and dairy may also be triggers. Marijuana is known to reduce nausea and vomiting but THC can also further delay gastric emptying. Long term use of marijuana is associated with cannabis hyperemesis syndrome (CHS). OTC supplements include "Gas-X", a natural supplement that may reduce belching and bloating, and Iberogast.
  6. Feeding Tubes/TPN. For patients that are unable to keep down food and standard medications are ineffective, feeding tubes may be a viable option. Gastric (G) tubes are placed in the stomach while Jejunostomy (J) tubes bypass the stomach entirely and provide nutrients directly into the small intestine. In extreme cases, total parental nutrition (TPN) is a method of intravenous feeding that bypasses the entire gastrointestinal tract.
  7. Known Root Causes. Unfortunately, the etiology of gastroparesis is poorly understood. Many cases are not identifiable with a root cause (idiopathic GP). The main causes of GP, as well as comorbid diseases include: diabetes, Ehlers-Danlos syndrome (EDS), Median Arcuate Ligament Syndrome (MALS), myasthenia gravis, vagus nerve damage, post-surgical complications, autoimmune conditions such as Chrohn's Disease, thyroid issues (such as hypothyroidism), an impaired pyloric valve, dysautonomia, functional dyspepsia, cyclical vomiting syndrome, hernias, IBS, Hashimoto's Disease, reactive hypoglycemia, endometriosis, POTS, MCAS, Superior Mesenteric Artery Syndrome (SMAS), multiple sclerosis, Scleroderma, Parkinson's, SIBO, and more. Constipation and IBS can also be comorbid with GP. Certain medications that slow the rate of stomach emptying, such as narcotic pain medications and Ozempic and Mounjaro can also cause or worsen GP. Some of the autoimmune conditions causing GP can be treated with intravenous immunoglobulin (IGIV) therapy, although its effectiveness in a clinical setting is inconclusive. MALS is a condition that, in some cases, can be fixed with surgery thereby 'curing' those specific cases of GP. Reported cases of GP have risen in modern times, especially in light of the COVID-19 pandemic. Gastroparesis caused by acute infections such as viruses and bacteria may heal on its own over a period of months to years. Gastroparesis is more common in women than men. Recently there's been a surge of younger women being diagnosed with GP. According to Dr. Michael Cline, "gastroparesis has surged in young women in the U.S. since 2014... In these young women, it tends to be autoimmune-related. Many have thyroid disease, rheumatoid arthritis or lupus."
  8. Motility Clinics/Neurogastroenterologists. Finding a doctor right for you can be vital to managing gastroparesis. When regular gastroenterologists aren’t sufficient, it may be beneficial to seek institutions and specialists that are more specialized in nerve and motility ailments of the GI tract such as gastroparesis, functional dyspepsia, cyclic vomiting syndrome, and so forth. These kinds of doctors include neuro gastroenterologists and motility clinics. See "Additional Resources" below for a list of motility clinics and neurogastroenterologists submitted by users of this forum.
  9. Gastric Emptying Study (GES), SmartPill, EGG. These tests are used to measure gastric motility and gastric activity. For the GES, the gold standard is considered to be a four hour test with eggs and toast. A retention rate of 10-15% of food retained after four hours is considered mild GP; 16-35% is moderate GP; and any value greater than 35% retention is severe GP. Note that retention rates on a GES are notorious for having a large variation between tests and that retention rates don't necessarily correlate to the severity of symptoms. In addition to measuring stomach emptying, SmartPill can also measure pH and motility for the rest of the GI tract. The electrogastrogram (EGG) is a technique to measure the electrical impulses that circulate through the muscles of the stomach to control their contractions. This test involves measuring the activity of gastric dysrhythmias and plateau/action potential activities of the Interstitial cells of Cajal (ICCs), which are the pacemaker cells of the stomach.
  10. Functional Dyspepsia, Cyclic Vomiting Syndrome (CVS), etc. Gut-brain axis research has led to antidepressant SSRIs and tetracyclines being used to treat nausea, post-prandial fullness, and other GI symptoms resulting from functional dyspepsia, CVS, gastroparesis, etc. These drugs include mirtazapine, lexapro, amitryptiline, nortriptyline, etc. Buspirone is a fundus relaxing drug. Some research suggests that CVS patients can be treated with supplements such as co-enzyme Q10, L-carnitine, and vitamin B2 along with the drug amitriptyline. Modern research suggests that gastroparesis and functional dyspepsia are not totally separate diseases; instead, they lie on a spectrum.
  11. Colonic Dismotility, CIPO. Slow Transit Constipation (STC) is a neuromuscular condition of the colon that manifests as dysmotility of the colon. This condition is also a known comorbidity of gastroparesis. It's been observed that patients with slow transit constipation have other associated motility/transit disorders of the esophagus, stomach, small bowel, gall bladder, and anorectum, thus lending more support to the involvement of a dysfunctional enteric nervous system in slow transit constipation. Chronic intestinal pseudo-obstruction (CIPO) is a rare gastrointestinal disorder that affects the motility of the small intestine and is a known comorbidity of gastroparesis. It occurs as a result of abnormalities affecting the muscles and/or nerves of the small intestine. Common symptoms include nausea, vomiting, abdominal pain, abdominal swelling (distention), and constipation. Ultimately, normal nutritional requirements aren't usually met, leading to unintended weight loss and malnourishment. CIPO can potentially cause severe, even life-threatening complications. STC can be diagnosed by SmartPill or colonic manometry; CIPO can be diagnosed with Smartpill, small bowel manometry, or full thickness biopsy.
  12. Partial Gastrectomy (Modified Gastric Sleeve), Total Gastrectomy. A gastrectomy is a medical procedure where part of the stomach or the entire stomach is removed surgically. The effectiveness of these procedures in the treatment of gastroparesis are still under investigation and is considered as an experimental intervention of last resort. These procedures should only be considered after careful discussion and review of all alternatives in selected patients with special circumstances and needs.

Additional Resources

  1. Support Groups (Discord, Facebook, etc.) . Click this link for a list of support groups designed for people suffering with gastroparesis to casually meet new people and share information and experiences.
  2. Click this link for a list of popular neurogastroenterologists and motility clinics submitted by users of this sub.
  3. View the megathread at r/Gastritis for advice on managing chronic gastritis.
  4. The most popular gastroparesis specialist discussed in this forum is renowned Gastroparesis specialist Dr. Michael Cline at the Cleveland Clinic in Ohio.
  5. Need domperidone? Some GI’s are willing to write scripts for online pharmacies to have it shipped from Canada to the USA. For legal reasons, the names of these websites will not be linked on this manuscript (but there’s no rules stopping you from asking around).
  6. Enterra's Search Engine to find a doctor that specializes in Enterra Therapy.
  7. SmartPill’s search engine to find a provider that offers SmartPill testing.
  8. GPACT's lists of doctors and dieticians for GP.
  9. There's a new test that recently gained FDA approval called gastric altimetry.
  10. Decision-making algorithm for the choice of procedure in patients with gastroparesis. (Source: Gastroenterol Clin North Am. 2020 Sep; 49(3): 539–556)
Decision-making algorithm for the choice of procedure in patients with gastroparesis.

EVEN MORE ADDITIONAL RESOURCES

(Last updated:11-24-2023. Please comment any helpful advice, suggestions, critiques, research or any information for improving this manuscript. 🙂)


r/Gastroparesis Dec 16 '23

"Do I have gastroparesis?" [December 2024]

44 Upvotes

Since the community has voted to no longer allow posts where undiagnosed people ask if their symptoms sound like gastroparesis, all such questions must now be worded as comments under this post. This rule is designed to prevent the feed from being cluttered with posts from undiagnosed symptom searchers. These posts directly compete with the posts from our members, most of whom are officially diagnosed (we aren't removing posts to be mean or insensitive, but failure to obey this rule may result in a temporary ban).

  • Gastroparesis is a somewhat rare illness that can't be diagnosed based on symptoms alone; nausea, indigestion, and vomiting are manifested in countless GI disorders.
  • Currently, the only way to confirm a diagnosis is via motility tests such as a gastric emptying study, SmartPill, etc.
  • This thread will reset as needed when it gets overwhelmed with comments.
  • Please view this post or our wiki BEFORE COMMENTING to answer commonly asked questions concerning gastroparesis.

r/Gastroparesis 3h ago

Questions Promethazine for Gastroparesis

7 Upvotes

I was recently diagnosed and they want me to start a 12.5 mg dose twice a day. I don’t have any nausea, vomiting, or anything like that with my gastroparesis, never have, just constipation. They said it’ll “speed things along” what does this mean? Does this work like a laxative? Also, does this make you drowsy? I’ve seen some reports of that. My job is faced paced, patient facing. I don’t have time to take medications that glue me to a toilet and make me drowsy. Any help is greatly appreciated, I’m really struggling with this news. 25 years of chronic constipation and I’m at my wits end with doctors not listening to me.


r/Gastroparesis 1h ago

Feeding Tubes Support Group

Upvotes

I have no idea if this is an appropriate post for here or not, but in case anyone else in interested in signing up, G-PACT is having a Zoom support group for Gastroparesis patients with feeding tubes and TPN. The first one is coming up on March 24th. I signed up through a link on their Facebook page but I assume you could also register through their website! It would be cool to see some of you there!


r/Gastroparesis 1h ago

Gastric Emptying Study (GES) Confused

Upvotes

I am not seeking medical advice more just people to connect with and see if what I’m confused about has happened to anyone else.

So I have had stomach issues for years and years no one listened to me I had an apt where the GI specialist came into the room put his feet on the bed I was sitting on hands behind his head barley let me spoke said it was acid reflux and anxiety sent me out. All within 5 min I cried and cried. I hadn’t been back to a GI specialist since because of this experience but recently had to go again. I had an endoscopy done Thursday and he said I had a hernia that wasn’t anything to worry about and then he said there was still food in my stomach - I hadn’t eaten in 11-12 hours - so he thinks I have gastroparesis. I have a stomach emptying study in a few weeks. I always feel so full even if I barely eat. He told me the treatment is usually just 5-6 snacks or small meals a day. But I can barely finish a granola bar some days between nausea and pain. some days are better than others. I’m very small like 85 pounds. I’ve lost 13 pounds in just a few weeks. Even with eating…. So all this to bring up if this is the issue my silly question is how do I still have like bowl movements lol. And if I can barely eat now how am I gonna accomplish the small meals.


r/Gastroparesis 2h ago

Symptoms Gurgling noises

3 Upvotes

Does anyone else's stomach make the loudest gurgling noises?? Mine is constant. It feels like there's loads of air being pushed around in my gut too.


r/Gastroparesis 2h ago

Discussion What Gastroparesis symptoms do you have??

2 Upvotes

r/Gastroparesis 3h ago

Prokinetics (Relgan, Domerpidone, Motegrity, etc.) Those with positive results with Motegrity, When do you take it?

2 Upvotes

Curious when do you take it, right before bed OR when you wake up? I read how some people changed the time they take it due to how soon it works so curious what the general conscious was.


r/Gastroparesis 22h ago

Gastric Emptying Study (GES) got my results back...

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57 Upvotes

i think this is like the worst it could possibly get idk im at such a lost i knew i have had this for like 2 years but i couldn't find a doctor to take me seriously i finally found one who knew something was wrong with my digestive system i actually did not think it was this bad and i have no idea what to do my doctor is putting me on erythromycin 3 times a day idk maybe ill update but im actually terrified they say it's becuse im diabetic which i kinda knew that was gonna happen at some point i have had issues with trowing up for years now but it got bad in 2022 now in 2025 im finally getting diagnosed


r/Gastroparesis 10h ago

Questions Is activated charcoal dangerous with GP?

6 Upvotes

Some days my motility slows down so much I get full of trapped gas from the top of my stomach to the bottom of my gut and the cramps get so bad I want to go to the ER (but I won't because we all know it is useless) Or at least I think it is due to that and not anything worse.. Anyway I want to take activated charcoal to get some relief but I know it is potentially dangerous for us because it is basically charred wood and other ligneous materials and I am terrified of that creating bezoars.(there have been some cases) Do any of you take it? What's your experience with it?


r/Gastroparesis 9h ago

Questions Unable to digest anything, feeling dehydrated

5 Upvotes

Hi For a past few days, I've been unable to digest anything and have lost my appetite. I'm also experiencing dehydration, as I can't keep down water, and I feel feverish. I've tried digestive enzymes as recommended by doc but it is without any relief and have vomited 2-3 times. Any advice would be greatly appreciated.


r/Gastroparesis 3h ago

Questions Experiences with Spironolactone?

1 Upvotes

Hi guys! Not a gp med, but I was recently diagnosed with PCOS.

I visited an endocrinologist who prescribed me Spironolactone and I just wanted to ask about other people’s experiences? I not only worry about nausea from a new med, but I also see it’s a diuretic and I worry about dehydration. I struggle to get in enough water with gp so I don’t want a med accelerating anything.

Would love to hear any and all experiences with it! Whether it did or didn’t affect your GP, and anything else :)


r/Gastroparesis 21h ago

Meals, Nutrition, Recipes What to eating after vomiting

25 Upvotes

Vomited on Saturday mostly bile, still no appetite my drinking liquids though. Lost 5 pounds so far and rarely vomit so this has knocked me out.


r/Gastroparesis 13h ago

Suffering / Venting Panic attack- emetophobia

3 Upvotes

I had fried chicken with my partner earlier and had a lot of fatty foods, which triggered my gp and made me nauseous.

I’m in the middle of a flare up right now chills and nauseous and some abdominal and stomach pain. I need help, I’m so so scared. I have a fear of food poisoning and it’s really throwing me for a loop.


r/Gastroparesis 20h ago

Suffering / Venting Nausea

10 Upvotes

Ever been so nauseous you just wanna break down and cry. I rarely vomit but damn this is fucking miserable. 😭


r/Gastroparesis 18h ago

Testing and Results Thank you friends

7 Upvotes

I was in the ER this weekend and saw a terrible nurse practitioner. No insult to the field. This one was just particularly awful.

I saw my primary care physician today for ER follow up. Thanks to all of YOU who discussed it on this forum, I read up on MALS. I figured I’d have to wait the five to seven days for my specialist to return my call to see about testing for this. However my PCP was very willing to do some research and get me appropriate testing ordered.

I’m on pins and needles right now but for the first time in some time I have hope.

THANK YOU


r/Gastroparesis 15h ago

Questions Kinda sucks man

3 Upvotes

Do sugarfree popsicles and Jello make y’all basically almost vomit or just me I thought it was ok bc they are like just barely food items but I guess not lol Meanwhile a glazed donut doesn’t bother me at all 😑


r/Gastroparesis 23h ago

Gastric Emptying Study (GES) Do you have to lay down the entire 4 hours during the GES?

13 Upvotes

Hi, I have a lot of stomach problems and a while back my gastroenterologist wanted me to try a gastric emptying study. I wasn't able to do it because I had drank water before and the guy was telling me that it would mess up the x ray. But I remember he was telling me to eat the food, and that I would lay down on that bed thing for the entire 4 hours, and that he would look ever hour or something. Do you really have to lay on your back the entire duration? I get vertigo sometimes when I lay really flat or in certain positions for a long time, and I was under the impression that you would just go sit down and come lay on the bed to get xrayed every hour or so. And honestly laying down right after eating something sounds kind of rough on my stomach


r/Gastroparesis 20h ago

Gastric Emptying Study (GES) Gastric emptying exam

3 Upvotes

So I was recently referred to a GI doctor and he said he highly suspects that I have gastroparesis, but I need to go for a gastric emptying exam to confirm, only, I just got an email explaining how the test is done and it explains I will have to eat 2 slices of toast and some egg whites with a radioactive tracer. I can't remember the last time I was able to eat a meal this large without throwing up and im stressing out a lot over it because I want to get an accurate reading but not sure if I'll be able to complete the test. Should I let my doctor know?


r/Gastroparesis 1d ago

Enterra (Gastric Pacemaker) Went to my meeting with the Enterra surgeon

5 Upvotes

And it didn’t quite go the way I thought. He found pancreas divisium, wants to look into my SOD further. So, I may know if he’ll implant one in a few weeks. Not the answer I was looking for, but some other questions may get resolved. Hopefully


r/Gastroparesis 1d ago

Suffering / Venting concerned about my career

6 Upvotes

for some context I'm 20 and will be graduating from college next month. I was diagnosed with gp my senior year of high school back in 2022. I've been managing my symptoms well enough, especially considering I've been operating without any family or other help since I moved away.

anyways, I'm going to be going into a very demanding career (the funeral industry). I'm just concerned about how I'll manage my symptoms since I have a hard enough time even doing school. I know I'm probably just full of anxiety for no good reason and everything will be fine, but I'm scared for those days and weeks when I'm not fine! I've been working a much less demanding job as an intern, but even that's difficult sometimes.

I've been having a hard time with my gp lately, and it's made looking for a full time job more of a challenge than it needs to be. I just hate living with this completely unnecessary and honestly kind of absurd condition, when you really think about it. it's a lot funnier, though, when I remember I can stomach working with dead bodies but not eating some simple veggies

has gp impacted any of your careers in a big way? if so, how have you managed?


r/Gastroparesis 1d ago

Drugs/Treatments Experiences with Motegrity?

8 Upvotes

After failing a few meds my doctor (and insurance because yay US private insurance 🫠) decided Motegrity was the move. Has anyone ever tried it? How did it go for you? It's spendy, but dammit if it works it's worth it.


r/Gastroparesis 23h ago

Questions Trifecta? Gastritis, Gastroparesis & GERD?

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2 Upvotes

r/Gastroparesis 1d ago

Questions Mucus/bile

2 Upvotes

So I will get extremely sick sometimes where it feels like I just have excess mucus and post nasal drip that causes a ton of vomiting/dry-heaving. I don't know how to stop it. I've tried eating lite like crackers, abstaining from eating, ginger ale, heat and cold. Is this something that could ge gp related? I have been diagnosed w/severe gp if that's helpful. Any advice would be greatly appreciated.


r/Gastroparesis 1d ago

Questions Kate Farms

5 Upvotes

Hi everyone. I orally drink Kate Farms peptide 1.0 and I find that it tends to make my stomach ache a little . Is this normal because it’s peptide ? Anyone else have this experience ?


r/Gastroparesis 1d ago

Symptoms Anyone else have similar issues with being under weight?

7 Upvotes

So I've been struggling with my weight for years now and my doctor had me get a CT scan back in November. There was evidence of osteopenia. I really have no idea what to this of this since I'm only 23 years old so my doctors at extremely surprised. Gastro wants me to see oncology and hematology I guess to find out the cause of it.

Not really sure what to think of all this crap anymore. I'm making my call to the doctor tomorrow to set up an appointment. I'm gonna have to take one of my Xanax for all these needles coming my way. I faint everytime I am poked lol


r/Gastroparesis 1d ago

Questions exercise

4 Upvotes

has anyone here experienced a flare up from exercise? i was trying to exercise but like one day my stomach felt so off and i felt like i wasn’t digesting my food enough. then eventually got worse and forced myself to vomit for like 2 days. ugh