Gastroparesis Treatments and Medications

People with gastroparesis, or “stomach paralysis,” may see a meal as a possible source of pain, nausea, vomiting, and bloating. Gastroparesis is the slow or delayed emptying of the stomach without a physical blockage, and it’s often caused by diabetes-related nerve damage, stomach or vagus nerve surgery, certain medications such as opioids and GLP-1 drugs, or, in nearly half of cases, no identifiable cause at all. Although gastroparesis is not curable, it can be managed through dietary and lifestyle changes, as well as medications or procedures. If you have constant nausea or fullness after small meals, see a healthcare provider, as untreated gastroparesis could lead to problems like dehydration and malnutrition.

How is gastroparesis diagnosed?

A healthcare provider can diagnose gastroparesis by first looking for typical symptoms, such as chronic nausea, vomiting, early fullness, bloating, acid reflux, and stomach or abdominal pain. They may also perform an upper endoscopy and sometimes a CT scan, MRI, or a barium X-ray to see if there’s a blockage. If no blockage is found, they can perform other tests:

• Gastric emptying scintigraphy: This is the gold standard for diagnosis, in which you eat a meal containing a small amount of a tracer that helps measure how much food remains after four hours.

• Wireless motility capsule: For people who can’t undergo a gastric emptying scintigraphy, a gastrointestinal monitoring capsule can be swallowed instead to record how long it takes to move out of the stomach.

• Carbon-13 breath test: This test measures stomach emptying by tracking the carbon-13 isotope in your breath and is also useful when scintigraphy is not an option.

If there is a significant delay in stomach emptying, your healthcare provider can identify potential causes. The results of these tests can also be used to find the most appropriate treatment option, such as diet changes or medication.

Gastroparesis treatment options

There is no cure for gastroparesis. Instead, treatment is mainly focused on relieving symptoms, preventing malnutrition, and managing the underlying cause. Most people start with dietary changes, with medications added to help speed up stomach emptying or control nausea. In severe cases, a feeding tube, gastric electrical stimulation, or even surgery may be recommended. Healthcare providers typically base the treatment on what’s causing gastroparesis, how severe the symptoms are, and whether the person has other conditions like diabetes. 

Types of gastroparesis medication

Medications that treat gastroparesis either increase stomach muscle contractions (prokinetic agents) or reduce nausea (antiemetics).

Prokinetic medications

Prokinetics are a type of medication that can help increase the strength of muscle contractions in the stomach and the frequency of these contractions. Reglan (metoclopramide) is the first-line drug prescribed for gastroparesis and is given as an injection, tablet, or liquid. Domperidone may work similarly and with fewer side effects on the nervous system, but it is only available through a special FDA access program.

Macrolide antibiotics

Certain antibiotics may also act as prokinetic agents. Erythromycin is sometimes used to stimulate stomach contractions and may be prescribed when metoclopramide doesn’t work well enough. Erythromycin, though, has potentially severe side effects, so some healthcare providers may prescribe azithromycin, especially for people at higher risk of heart rhythm problems.

Antiemetics

Antiemetics, or anti-nausea medications, can be used to help manage nausea and vomiting from gastroparesis. Potential options include antihistamines like promethazine and meclizine, phenothiazines like prochlorperazine and perphenazine, and serotonin (5-HT3) blockers like ondansetron and granisetron. These drugs can help calm the vomiting center in the brain.

Over-the-counter gastroparesis medicine

There are no OTC medications approved to treat gastroparesis directly. However, some antiemetics like meclizine can be found over the counter to help manage mild nausea. Liquid supplements like Ensure can also help provide nutrition when it’s hard to tolerate solid foods. More important than looking for an OTC medicine is avoiding OTC products that could potentially worsen symptoms, including anticholinergic antihistamines such as diphenhydramine, NSAIDs such as ibuprofen and aspirin, and bulk-forming fiber laxatives. Consult a healthcare provider if you’re unsure about taking an OTC medicine.

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Best medications for gastroparesis