Fortunately, there are prescription
medications to treat gastroparesis. Often a combination of
medications are used to determine the most effective treatment. The
list of medications is short and includes:
#1. Metoclopramide
(Reglan). This medication stimulates stomach muscle
contractions to help with gastric emptying. Metoclopramide also
helps reduce nausea and vomiting. The medication is taken 20 to 30
minutes before meals and at bedtime. Possible side effects of
metoclopramide include fatigue, sleepiness, and depression.
Currently, this is the only medication approved by the FDA for
treatment of gastroparesis. The FDA has placed a black box
warning on this medication because of rare reports of it causing
an irreversible neurologic side effect called tardive dyskinesia,
which is a disorder that affects movement.
#2. Erythromycin.
This antibiotic, prescribed at low doses, may improve gastric
emptying. Like metoclopramide, erythromycin works by increasing the
contractions that move food through the stomach. Possible side
effects of erythromycin include nausea, vomiting, and abdominal
cramps.
#3. Other medications.
Other medications may be used to treat symptoms and problems
related to gastroparesis. For example, medications known as
antiemetics are used to help control nausea and vomiting.
#4. This is not a medication
and care should be used if you allow this. Botulinum toxin is
a nerve-blocking agent also known as Botox. After passing an
endoscope into the stomach, a doctor injects the Botox into the
pylorus, the opening from the stomach into the duodenum. Botox is
supposed to help keep the pylorus open for longer periods of time and
improve symptoms of gastroparesis. Although some initial research
trials showed modest improvement in gastroparesis symptoms and the
rate of gastric emptying following the injections, other studies have
failed to show the same degree of effectiveness of the Botox
injections.
There are procedures that are also used
and have varying degrees of success. The following are the ones used
currently:
#1. Gastric Electrical Stimulation
This treatment alternative may be effective for some people whose
nausea and vomiting do not improve with dietary changes or
medications. A gastric neurostimulator is a surgically implanted
battery-operated device that sends mild electrical pulses to the
stomach muscles to help control nausea and vomiting. The procedure
may be performed at a hospital or outpatient center by a
gastroenterologist. General anesthesia may be required. The
gastroenterologist makes several tiny incisions in the abdomen and
inserts a laparoscope—a thin tube with a tiny video camera
attached. The camera sends a magnified image from inside the stomach
to a video monitor, giving the gastroenterologist a close-up view of
the tissues. Once implanted, the settings on the battery-operated
device can be adjusted to determine the settings that best control
symptoms.
#2. Jejunostomy
If medications and dietary changes don’t work, and
the person is losing weight or requires frequent hospitalization for
dehydration, a health care provider may recommend surgically placing
a feeding tube through the abdominal wall directly into a part of the
small intestine called the jejunum. The surgical procedure is known
as a jejunostomy. The procedure is performed by a surgeon at a
hospital or outpatient center. Anesthesia is needed. The feeding
tube bypasses the stomach and delivers a special liquid food with
nutrients directly into the jejunum. The jejunostomy is used only
when gastroparesis is extremely severe.
#3. Parenteral Nutrition When
gastroparesis is so severe that dietary measures and other treatments
are not helping, a health care provider may recommend parenteral
nutrition—an IV liquid food mixture supplied through a special tube
in the chest. The procedure is performed by a surgeon at a hospital
or outpatient center; anesthesia is needed. The surgeon inserts a
thin, flexible tube called a catheter into a chest vein, with the
catheter opening outside the skin. A bag containing liquid nutrients
is attached to the catheter, and the nutrients are transported
through the catheter into the chest vein and into the bloodstream.
This approach is a less preferable alternative to a jejunostomy and
is usually a temporary treatment to get through a difficult period of
gastroparesis.
My friend and member of our support
group, Allen, says that one of his friends had the last procedure and
had to remain in the hospital to fight a resulting infection and does
not recommend the last procedure above.
For a comparisons of information please
read this. Or you can also enter gastroparesis in your search
engine and do your own search.
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