Gastroparesis Treatments: From Lifestyle Changes To G-POEM

Most people with gastroparesis, a condition where your stomach takes too long to empty when it's full, can manage their symptoms with dietary changes, medications and blood sugar control. But for some, conservative treatments aren't enough. When symptoms like nausea, vomiting and bloating continue, more advanced options are available — including a procedure called gastric peroral endoscopic myotomy (G-POEM).

"If you've tried conservative approaches to treat gastroparesis and you're still struggling, there are other options," Mohammad Arfeen, DO, a gastroenterologist with Franciscan Health, said. "G-POEM is one of them, but it's typically an option for patients who haven't had success with diet, lifestyle changes or medications."

Key Takeaways: Gastroparesis Treatments

• Symptoms like nausea, vomiting, bloating or early fullness that continue despite diet changes and medications may mean it's time to see a gastroenterologist.
  
• Not everyone with gastroparesis needs a procedure. For many people, gastroparesis treatment focuses on simple lifestyle adjustments, like eating smaller, more frequent meals, and short-term medical therapies.
• When lifestyle changes and medications aren't enough, doctors may explore other treatments that focus on the muscular ring at the exit of the stomach to help food move forward properly.

First Steps To Treat Gastroparesis

Not everyone with gastroparesis needs a procedure. For many, the first line of treatment focuses on lifestyle changes and short-term medical therapies. These can ease gastroparesis symptoms, improve nutrition and sometimes prevent the need for more invasive treatments.

Simple adjustments often make a big difference. Eating smaller, more frequent meals — about a fist-sized portion every few hours — puts less strain on the stomach. For people with diabetes, steady blood sugar is especially important because it helps protect the nerves that control digestion. In some cases, we may prescribe short courses of medication to improve stomach emptying or relieve nausea. While not usually a long-term solution, these medicines can be very helpful during flare-ups.

If your gastroparesis is related to diabetes, read more in our blog on diabetic gastroparesis.

Advanced Treatment Options For Gastroparesis

When lifestyle changes and medications aren't enough, doctors may explore other options that focus on the pylorus — the muscular ring at the exit of the stomach. If this muscle spasms or stays too tight, food can't move forward properly.

Temporary treatments for the pylorus

• Balloon dilation: We place a balloon in the pylorus and inflate it to stretch the muscle gently. This can temporarily improve stomach emptying.
• Botox injections: We inject botulinum toxin into the pylorus to relax it and make it easier to empty.

Both treatments are temporary and relief usually lasts weeks or months. However, Dr. Arfeen explained that if a patient responds to them, "It's a good sign they may also respond well to G-POEM."

Testing tools to guide treatment

A newer test, called EndoFLIP, uses a balloon with sensors to measure how tightly the pylorus squeezes in real time. Early studies suggest it may help predict which patients are most likely to benefit from G-POEM.

G-POEM: a more permanent option

For patients with severe, persistent symptoms, we may recommend G-POEM (gastric peroral endoscopic myotomy). It is a minimally invasive procedure that targets the pylorus.

"We make a small tunnel between the layers of the stomach wall, like sliding between sheets of paper," Dr. Arfeen said. "Through that tunnel, we reach the pylorus and cut the muscle ring from the inside. We seal the stomach when we close the tunnel. By releasing that tight ring, food can empty from the stomach more easily."

G-POEM can provide lasting relief for patients whose symptoms are primarily nausea, vomiting and bloating — not pain.

Who Is A Candidate For G-POEM?

Not every patient with gastroparesis needs a medical procedure. But for some, lifestyle changes and medications aren't enough.

Dr. Arfeen explained that the best candidates for G-POEM are:

• Patients whose main symptoms are nausea, vomiting and bloating rather than pain
• Those who have tried conservative treatments like dietary changes and short-term medications with little to no relief
• Patients who have had temporary improvement after balloon dilation or Botox injections of the pylorus, since that response suggests they may benefit from a more permanent solution

Risks And Results Of G-POEM

Like any procedure, G-POEM has potential risks — but serious complications are rare.

• During the procedure: Less than 10 percent of patients may experience issues such as bleeding, infection or a small perforation (hole). Most are treated immediately during the procedure itself.
• After the procedure: The biggest concern is that it may not work for everyone. Dr. Arfeen explained, "G-POEM helps about 6 to 7 out of every 10 patients, but roughly a third may not see much improvement."
• Over-response: In rare cases, the stomach may begin to empty too quickly, leading to "dumping syndrome." While uncommon, this can cause diarrhea, cramping and dizziness after meals.

Even with these risks, many patients who undergo G-POEM find lasting relief from their symptoms — and can avoid more invasive options like gastric stimulators, feeding tubes or major surgery.

When To See A Doctor For Gastroparesis

If symptoms like nausea, vomiting, bloating or early fullness continue despite diet changes and medications, it may be time to see a gastroenterologist.

"Make sure you're optimized on medical therapy and have had appropriate dietary counseling," Dr. Arfeen advised. "If you still don't get relief, advanced options like G-POEM, Botox or gastric stimulation may help."

Franciscan Health offers comprehensive evaluation and treatment for gastroparesis, including advanced therapies like G-POEM for patients whose symptoms persist.

Learn more about gastroparesis and diabetic gastroparesis, or request an appointment to discuss whether G-POEM could be right for you.