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Gastroparesis Institute of USC

Testing and Treatment for Gastroparesis

Diagnostic Testing

Several other digestive disorders exhibit symptoms of nausea and vomiting. Your doctor will ask for some additional testing (after taking a complete medical history and performing a physical examination) in order to determine a diagnosis. This testing includes:

Primary Tests (required)

Upper Gastrointestinal Endoscopy. This test is used to exclude other conditions that may be causing symptoms (e.g., ulcers, physical abnormalities, or mechanical obstruction). A thin, flexible tube (endoscope) with a tiny camera at the tip is passed through the mouth and guided into the stomach while the patient is asleep. The endoscope allows the doctor to look into the stomach and at its lining for abnormalities.

Gastric Emptying Test (GET). This procedure measures the speed with which food empties from the stomach and enters into the small intestine. The GET, considered the most accurate way to diagnose gastroparesis, requires that the person eat a meal in which a solid food (usually eggs or oatmeal) contains a small and safe amount of a substance that will appear on a medical scan. A scanner is placed over the abdomen to monitor the food’s movement.

Secondary Tests (may not be necessary)

Gastroduodenal Manometry. In this test, the doctor passes a thin, pressure-sensitive tube down the throat and into the stomach and small intestine. A computer connected to the tube monitors the strength and coordination of stomach muscle contractions and how well the stomach is emptying. Electrogastrography (EGG). This procedure records the electrical signals in the stomach before and after eating. An irregular electrical rhythm may indicate the presence of gastroparesis.

Treatment Options

There is no cure for gastroparesis but several treatments are available that improve symptoms and offer a more comfortable lifestyle. Treatment options include:

Nutrition Education/Diet Modifications
Patients are often initially treated with nutrition education and diet modifications. The purpose of diet modification is to reduce symptoms and maintain adequate fluids and nutrition. A modified diet typically consists of liquids, restricted fats and plant fiber, and frequent small meals.

Medications
The most common drugs used to treat symptoms include:

  • Prokinetic drugs—used to improve the rate of stomach emptying and thereby reduce nausea and vomiting. Examples include erythromycin (an antibiotic) and Reglan® (metoclopramide).
  • Antiemetic drugs—used to control nausea and vomiting but have no effect on stomach emptying. Examples include Compazine® (prochlorperazine) and Phenergan® (promethazine).

Enteral Nutrition.
This therapy involves the delivery of liquid nutrients via a tube placed directly into the stomach or small intestine. Feeding tubes are usually temporary and used only when gastroparesis is severe.

Total Parenteral Nutrition (TPN).
TPN supplies nutrients to a person’s bloodstream through an intravenous (IV) infusion. TPN is used only if enteral feeding is not tolerated or is insufficient to meet caloric needs.

Surgery.
Surgery for gastroparesis is considered a treatment of last resort. One surgery, called pyloroplasty, involves widening of the pyloric valve (the muscle that separates the stomach from the upper region of the small intestine or duodenum). Another procedure, gastrectomy, involves the removal of part or all of the stomach. Other surgical procedures involve bypassing the lowest part of the stomach to improve emptying.

Enterra® Therapy for Gastroparesis.
This surgical option is indicated for patients with chronic, drug-refractory (resistant to medication) nausea and vomiting due to gastroparesis of diabetic or idiopathic origin. Enterra Therapy uses a neurostimulator that is implanted beneath the skin and connected to two leads implanted in stomach muscle. Your doctor can determine if you are a candidate for Enterra Therapy.

Any combination of diet modification, medication, nutritional support, and Enterra Therapy may be necessary to control symptoms of gastroparesis.

 

Next: Enterra Therapy for Gastroparesis

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USC Gastroparesis Institute
1510 San Pablo St., Suite 514
Los Angeles, CA 90033

Phone: (323) 442-6868

 
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