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Gastroparesis

Many people think of cystic fibrosis (CF) as a lung condition. This is because most CF symptoms happen as a result of lung problems. But people with CF can also have problems with other organs, such as parts of the digestive or gastrointestinal (GI) tract.1

Organs of the GI tract include the pancreas and intestines. When these organs become blocked with abnormal secretions, GI problems can happen. And because people with CF are living longer, more and more are running into GI problems. One of these problems is gastroparesis (slow movement of food from your stomach to small intestine).1

What is gastroparesis?

Gastroparesis is also called “delayed gastric emptying.” It happens when your stomach muscles do not work well. Food exits slowly from your stomach, delaying digestion. Gastroparesis can lead to a range of problems, including:2,3

  • Dehydration
  • Poor nutrition
  • Uncontrolled blood sugar
  • Low calorie intake
  • Losing weight without trying
  • Low quality of life

Talk to your doctor if you notice signs of any of these problems.

How is gastroparesis diagnosed?

Doctors diagnose gastroparesis using your medical history, tests, and symptoms. To learn about your medical history, your doctor may ask:3

  • About medicines you take
  • If you have had surgery on your esophagus, stomach, or small intestine
  • Whether you have other health problems, such as diabetes or hypothyroidism

Your doctor may also perform certain tests, including:3

  • Measuring your blood pressure, temperature, and heart rate
  • Checking your abdomen for sounds or pain
  • Testing your blood and urine for dehydration, diabetes, and other problems
  • Imaging (such as an ultrasound) to look for blockage
  • Other tests to measure stomach emptying (such as scintigraphy)

Your doctor will also ask about your symptoms. Common symptoms of gastroparesis include:3

  • Feeling full right after starting a meal and long after eating a meal
  • Nausea and vomiting
  • Belching
  • Feeling bloated
  • Pain in your upper abdomen
  • Heartburn
  • Low appetite

Certain drugs may slow down food exiting from the stomach. These drugs do not cause gastroparesis. But if you have gastroparesis, they may make your symptoms worse. Make sure your doctor knows what medicines you take.3

What is the link between CF and gastroparesis?

Doctors cannot identify the cause of gastroparesis for most people. Diabetes is the most common cause of gastroparesis. But other conditions are linked to gastroparesis, including CF.3

People with CF have abnormal secretions and salt levels in the GI tract. The material may be thicker and stickier. This can cause stomach contents to move more slowly into the intestines.4,5

It is still hard to make definite connections between gastroparesis and CF. One study found that almost 40 percent of people with CF have gastroparesis. But other studies found that people with CF have no more risk of gastroparesis than anyone else. These varied results may be due to the use of different diagnostic methods.4,5

People with CF who receive a lung transplant may have a higher risk of gastroparesis. One study found that 75 percent of people with CF who had a lung transplant developed gastroparesis. No other conditions increased the risk of post-transplant gastroparesis.4-6

How can people with CF manage gastroparesis?

Management of gastroparesis can be hard. Many treatments have not been fully studied in people with CF. Management usually starts with diet and lifestyle changes, such as:3

  • Low-fat meals
  • Low-fiber meals
  • Frequent small meals

But people with CF have high caloric needs. So these changes may not be practical for them.

The only drug the US Food and Drug Administration (FDA) has approved for gastroparesis is metoclopramide (Reglan®). Doctors warn against using metoclopramide longer than 3 months. That is because using metoclopramide for a long time can increase the risk of uncontrolled face movements (tardive dyskinesia).4,5

Certain antibiotics (such as erythromycin and azithromycin) may improve symptoms of gastroparesis. We do not have enough information yet about how to use them in people with CF. Other drugs used to manage gastroparesis may help. But these other drugs also have not been studied enough in people with CF. These drugs include:4,5

  • Buspirone (BuSpar®)
  • Prucalopride (Resolor®)
  • Mirtazapine (Remeron®)
  • Tegaserod (Zelnorm™)

Feeding tubes are another way to manage gastroparesis. Oral and nasal feeding tubes bypass your stomach to deliver the right nutrients to the small intestine. A longer-term option is tube feeding through a jejunostomy – a surgically created opening in your abdomen.3-5

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