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Scott Webb (Host): I'm Scott Webb. And today, we're discussing gastroparesis, including the signs, symptoms, and treatment options with Dr. Owaise Mansuri. He's an endocrinologist with Carle.

Doctor, it's nice to have you here today. We're going to talk about gastroparesis. And I have to admit, I don't know what that is exactly. I've heard the word, but you're the expert. So, what is that? And maybe what are some of the symptoms that folks experience?

Dr. Owaise Mansuri: Gastroparesis is delayed gastric emptying. And symptoms can include nausea, vomiting. A lot of patients will say they're feeling full faster than usual. So, early satiety. They may complain about bloating and even some abdominal pain.

Host: Yeah. So, give us an idea there of some of the symptoms that folks might experience. It might get them to speak up to their, you know, primary doctor, possibly see a specialist, but what are some of the causes of gastroparesis?

Dr. Owaise Mansuri: you know, the most common is probably what's called idiopathic, meaning we don't know. But diabetes in late stages, that can cause gastroparesis due to nerve damage. And any neurological condition that can affect the nerves to the gut can cause that as well, such as like Parkinson's disease or multiple sclerosis or even a tumor or a stroke.

If patients had some form of gastric surgery where there can be nerve damage that can also cause gastroparesis. And then, of course, there's a big category of medications. So, opiates can cause gastroparesis, tricyclic antidepressants, dopamine agonists, cannabis can as well. And then, right now, we're seeing more cases of the category of the GLP-1s that are causing gastroparesis as well.

Host: Yeah, I wanted to ask you about that. I was reading about some of the maybe side effects of GLP-1s and GLP-1's relationship now to gastroparesis. Maybe you could take us through that.

Dr. Owaise Mansuri: So, GLP-1s have been around for quite a while now, for at least 20 years. And so, it's not a new category of medicines, but just the newer medicines are more potent than the original drugs. And so, the gastroparesis is a side effect, because these medications slow down gastric emptying. And, you know, patients feel full-faster, so they don't eat as much, and then that's how they lose weight. That's one of the effects of how they lose weight.

These medications, the ones that are on the market now, all start off with a lower dose to get the body and the gut used to the medication to help sort of slow down the effect of the gastroparesis, and so that patients are able to tolerate it better. But some patients do experience gastroparesis where it's very severe and have, you know, severe nausea and vomiting, and there aren't able to tolerate it. And so, those patients would typically need to stop the medication, and some patients have to stop one medicine, but they tolerate another medication just fine.

So, sometimes it's just, you know, switching to a different medication in that category. And usually, though, the patients do become tolerant of the symptoms. And so, the side effects do get better as time goes on.

Host: I see. Yeah, interesting. Wondering, how do you diagnose? We're talking about gastroparesis here and a variety of symptoms and a variety of possible causes. So, take us through the diagnosis process of gastroparesis.

Dr. Owaise Mansuri: So, obviously, it's based on symptoms, and then more definitive testing would be with a gastric emptying study where they give a radioactive-labeled food and then see how much is emptied from the stomach. And based on that, they calculate a percent. And if it's so high, then it would be consistent with gastroparesis.

Host: Gotcha. Yeah. And you were talking about GLP-1s and the effect that they may have on folks may be causing sort of gastroparesis inadvertently or unintentionally. But I want to talk about the treatment options. What are the treatment options for—as you mentioned, you could maybe change medications might be one thing you could do. But in general, what are the treatment options available to folks for gastroparesis?

Dr. Owaise Mansuri: Sure. Obviously, first is determining the cause. And then, from there, you can start the treatment. So, if it is medication-induced, then obviously avoiding those medications as best as possible, switching medications, you know, from one GLP-1 to another after some time off.

If it's secondary to long-standing diabetes, then improving diabetes control can help. And then, there are dietary changes that patients can make, which include decreasing fat content, because fat slows down gut transport as well. So, cutting back on fat, intake can help with that.

And then also, decreasing fiber, which, you know, is counterintuitive to what we want patients to do. But decreasing fiber intake can also help with gastroparesis symptoms. And then, we do have medications that are used for improving motility. One is metoclopramide, Reglan, and then another option would be an old antibiotic called erythromycin that we don't use as much, but that has also been used for this condition.

Host: Sure. Good stuff today, good to learn things about things like gastroparesis that I didn't already know, and I'm sure listeners agree. I'll just give you a chance here at the end, you know, final thoughts, ., But just generally for folks who are living with gastroparesis, perhaps they're undiagnosed at this point, what's your best advice?

Dr. Owaise Mansuri: Definitely talk to your doctor. Bring up these symptoms and talk to the doctor about, you know, getting tested and then seeing what treatments need to be done. Make sure you're hydrating well. That's always important, especially with the GLP-1, because that can cause dehydration as well.

Host: Well, that's perfect. I appreciate your time today, your expertise. I love when we get to topics that I haven't discussed before. So, great to have you here. Thanks so much.

Dr. Owaise Mansuri: Thank you.

Host: For more information and to get connected with one of our providers, please visit carle.org. And that wraps up this episode of Expert Insights with the Carle Foundation Hospital. I'm Scott Webb. Stay well.