Gastroparesis

Choosing Cleveland Clinic for your gastroparesis diagnosis and treatment means you can get care from healthcare providers from multiple specialties — all under one roof. Your experienced care team could include:

• Gastroenterologists (digestive system specialists).
• Radiologists (imaging specialists).
• Surgeons.
• Anesthesiologists.
• Endocrinologists.
• Dietitians.
• Psychologists.
• Advanced practice providers (certified nurse practitioners, physician assistants).

Diagnosing gastroparesis can be difficult since the symptoms are often similar to those of other digestive disorders. As part of your initial evaluation, we do a thorough and complete workup of your entire gastrointestinal tract to make sure that gastroparesis is the real issue. Our team will want to rule out:

• Chronic acid reflux (GERD).
• Heartburn.
• Irritable bowel syndrome (IBS).
• Stomach ulcers.

You’ll start your diagnosis process with a physical exam. When you come to your appointment, be prepared to answer questions about your eating habits, diet and medical history. It’s important to let your provider know if you’ve had GI surgery in the past or have other health conditions like diabetes.

Your provider will also look for signs of malnutrition. They’ll talk with you about your symptoms and how they affect your life. And you can also expect them to press down on your belly (abdomen) to check for swelling or tenderness.

Next, we’ll use a combination of routine and advanced tests to get to the bottom of your GI problems and confirm that you have gastroparesis. This can include:

Lab tests

Blood and urine tests tell your healthcare provider if you have malnutrition or dehydration from your GI issues. They’ll also look for signs of an infection or hyperglycemia (high blood sugar), which can trigger gastroparesis.

Upper GI series

An upper GI series uses fluoroscopy, a type of X-ray, to examine your esophagus, stomach and small intestine. You’ll drink barium (a white substance visible on X-rays) so that your provider can see how the barium moves through your digestive tract. It simulates how food would move through it when you eat.

Upper endoscopy

Your provider will insert an endoscope (thin, flexible tube with a camera) into your mouth and down your throat to look for blockages, inflammation or damaged tissue in your upper GI tract. Your provider will sedate you during the procedure. While an endoscopy is more invasive than a fluoroscopy, it shows more detail.

Gastric emptying studies

You’ll need to take a test that measures how well your stomach empties its contents into your small intestine. During a gastric emptying solid study, you eat a meal that contains a safe, radioactive isotope (tracer). We do imaging scans over a few hours, starting with one minute after you eat and again at one, two and four hours. This lets us see how the tracer moves through your digestive tract.

Or we may ask you to swallow a wireless motility capsule called a SmartPill™. The pill contains a tiny electronic device that sends information to an electronic recorder to show how quickly food travels through your digestive system.

We offer a wide range of gastroparesis treatments at Cleveland Clinic. We’ll personalize your treatments to you, your symptoms and your lifestyle so you can feel better as quickly as possible.

Minimally invasive gastroparesis treatment

We always try to do the least invasive treatment options first rather than moving right to talking about surgery. These could include things like:

• Diet changes: A registered dietitian works with you to adjust your diet and eating habits. We’ll help you maintain a healthy weight and avoid malnutrition. We may recommend eating frequent, small meals instead of two or three large meals each day. It’s important to make sure that these meals include high-fiber, high-calorie foods that are low in fat. Light activity after a meal, like walking, can also help digestion.
• Medication: Some medications, like metoclopramide, domperidone, cisapride or erythromycin, can help your stomach work better so its contents move into your small intestine faster. Other medications called antiemetics can ease your nausea and vomiting. If you have gastroparesis and diabetes, insulin can help maintain your blood glucose levels.
• Injections: We may inject botulinum toxin (Botox®) directly into your pylorus (the valve between your stomach and small intestine). Intrapyloric injections relax the muscle in this valve so your stomach can more easily empty its contents.
• Feeding tube or intravenous (IV) nutrition therapy: We may insert a tube in your nose or mouth to deliver a nutrient- and calorie-rich liquid directly to your small intestine, bypassing your stomach (enteral nutrition). Sometimes, we deliver nutrients through an IV needle in your arm (parenteral nutrition). These therapies are only for people who can’t get enough calories and nutrients by eating solid food.

Gastroparesis surgery

Gastroparesis surgery may be right for you if your symptoms don’t improve after you change your diet or take medication. At Cleveland Clinic, we specialize in an innovative, minimally invasive procedure called per-oral pyloromyotomy (POP).

During POP, we’ll insert an endoscope into your mouth and move it through your esophagus to your pylorus. We’ll open your pylorus with a small cut so food can better exit your stomach. POP doesn’t require a large incision in your belly, so you can recover faster and with less pain. Some people go home the same day as their procedure.

In addition to POP, we offer a range of other gastroparesis surgeries. Your provider will discuss each procedure’s risks and benefits with you before making a recommendation. Depending on your condition, surgical treatment may include:

• Gastric bypass surgery.
• Gastric pacemaker (gastric electrical stimulation).
• Gastrostomy.
• Jejunostomy (placing a feeding tube through your abdomen into your small intestine).
• Pyloroplasty.

Taking the Next Step

When eating makes you so sick that you don’t want to leave the house, it can take a physical and emotional toll on you — and limit your quality of life. Our experts are here to guide and support you through gastroparesis diagnosis and treatment every step of the way. We want you to get back to feeling like yourself again — and enjoy meals and fun times with your favorite people.