My 19-year-old daughter was diagnosed with Crohn's disease in the fourth grade. About six months ago, she had a severe flare-up. More recently, she contracted a stomach virus, and since then, has been plagued with diarrhea, nausea and vomiting. Her specialist said the problem is "delayed gastric emptying." What is delayed gastric emptying? How is it treated?

G.

Delayed gastric emptying, also known as gastroparesis, is a condition in which the stomach loses its ability to empty properly as a result of poor muscle function. The typical symptoms associated with gastroparesis include nausea, vomiting, bloating, weight loss and feeling of fullness after only a small amount of food is eaten.

Possible causes of gastroparesis include diabetes, stomach surgery, viral infections, scleroderma and neurological disorders, including Parkinson's disease and spinal-cord disorders. However, in many cases, no obvious cause for the gastroparesis is found.

Before a diagnosis can be made, doctors first rule out an obstruction of the stomach by performing an endoscopic examination or an X-ray study of the upper digestive tract. If no obstruction is found, doctors conduct another test in which the patient eats food that contains radioactive markers. X-ray pictures are taken of the stomach over the next few hours to see how quickly the food moves through it.

Therapy for gastroparesis includes dietary and medical components. A liquid diet is often prescribed because the stomach can often process liquids better than solids. Doctors may also advise the patient to eat smaller, more frequent meals. Metoclopramide (Reglan) and cisapride (Propulsid) can aid in stomach emptying by acting on the muscle in the stomach wall. However, these powerful medications can lead to certain side effects that may limit their use. Reglan can cause movement problems similar to those seen in Parkinson's disease, while Propulsid can interact with other medications to cause abnormal heart rhythms.[Editor's note: Because of such side effects, Propulsid's manufacturer decided to remove the drug from the market in July 2000. For more information, see the articleSubstitutes for Propulsid?]

It is also important to identify and treat any conditions that may have contributed to the gastroparesis. In the case of a viral infection of the stomach, only a few types of viruses (cytomegalovirus or herpesvirus, for example) would respond to specific therapy. In rare cases, gastroparesis is very resistant to treatment using the strategies mentioned. In these situations, a feeding tube may need to be placed into the patient's small intestine to provide enough nutrition. Alternatively, a surgical procedure to enhance emptying of the stomach may be necessary.

In all cases of delayed stomach emptying, close follow-up with a gastroenterologist is important to evaluate the disease course and to plan for further treatment.