Alt med ideas to help gastroparesis (non diabetic) patient anyone?

Question

I have a friend with gastroparesis and was hoping one of you altmed experts might have some ideas for us.

Answer 1

As yet, there is no cure for gastroparesis, but in most cases, symptoms can be improved with treatment. Regardless of the cause, treatment programs are fairly similar.

Diet

Changing how and what foods are eaten is helpful. It is best to eat six small meals a day, instead of three large ones. Liquid dietary supplements are often recommended since liquid meals pass through the stomach more easily and quickly. Avoid high fat foods that naturally slow gastric emptying and foods high in fiber like citrus and broccoli because the indigestible part will remain in the stomach too long.

Medications

Propulsid (cisapride) was developed to treat this condition and was of benefit to thousands of patients. Unfortunately, it was linked to about 300 cases of heart rhythm irregularity including 80 deaths and was taken off the market in 2000. With the removal of Propulsid, an older drug, Reglan (metoclopramide), has again become the drug of choice. It has been shown to be effective in the acute management of many gastroparetic conditions, but often loses its effectiveness over time. It can be given by mouth, intravenously (into the vein), subcutaneously (under the skin), and rectally. Unfortunately, side effects are common including drowsiness, loss of menstrual periods, impotence, and muscle spasms. With prologed use, some patients develop a Parkinson's-like tremor. Benadryl can limit some of the side effects but worsens the drowsiness.

Erythromycin has become the gastric prokinetic of choice for those patients who fail to respond to conventional agents. This antibiotic also acts to stimulate the muscles of the stomach to contract. It can be given intravenously and by mouth.

Domperidone (Motilium, Janssen) is another drug that improves gastric emptying and may have less side-effects. It has been available overseas (and even over the counter in Europe), but is not FDA approved in the US.

None of these drugs are totally effective and without side effects. Research is ongoing. Two new drugs that may possibly be helpful are Zelmac (tegaserod), a new drug for Irritable Bowel Syndrome with constipation and Viagra (sildenafil), which is marketed for male erectile dysfunction, but has also shown some benefit. Researchers at Johns Hopkins University found that part of the delay in stomach emptying occurs as a result of lack of nitric oxide in stomach tissues. The same basic molecular problem causes impotence in men. Experiments have shown that in mice Viagra reversed gastroparesis. Human trials are underway.

When nausea is a predominent symptom, a separate anti-nausea drug is often added such as Compazine (prochlorperazine) or Trans-Scop (scopolamine patches). But, again, side effects are common. In severe cases Zofran (ondansetron) may be used, but is very expensive. In milder cases of nausea, accupressure wrist bands are a non-invasive method that most patients tolerate well.

Surgery

Surgery is seldom done for gastroparesis, but in severe cases, a feeding jejeunostomy tube can be placed surgically. This thin plastic tube goes through the skin of the abdominal wall and directly enters the small intestine far downstream from the stomach. Special liquid nutrition given through this feeding tube bypasses the mouth, esophagus, and stomach and is delivered directly to the small intestine for absorption.