Dear Dr. Gott: In April 2000, I was diagnosed with gastroparesis. The recovery was very difficult, and I still have some gastric problems and off and on stomach issues. What is gastroparesis, and how is it treated?

Dear reader: Gastroparesis is a stomach disorder that leads to delayed emptying. This causes food to remain in the stomach for too long rather than move into the intestines for digestion.

The vagus nerve, which is responsible for the action of the muscles that control these organs, becomes damaged, leading to absent or reduced movement. Diabetes is the leading cause of gastroparesis.

High blood-glucose levels can cause chemical changes and damage to the nerves and blood vessels. This is why diabetes is also one of the leading causes of neuropathy (numbness, burning and tingling due to nerve damage) of the hands and feet.

If left untreated or poorly controlled, the damage can become more severe.

Other possible causes include Parkinson's disease, abdominal migraines, hypothyroidism, scleroderma, stomach surgery, eating disorders such as anorexia or bulimia and more.

There is also a form called idiopathic gastroparesis, which simply means that no cause can be found despite extensive medical testing. Symptoms can include nausea, heartburn, gastro-oesophageal reflux, abdominal bloating, little to no appetite, feelings of fullness after a minimal amount of food, abdominal spasms and/or pain, vomiting undigested food and more.

Ingesting solid, high-fibre, fatty or carbonated foods and drinks can also contribute to or worsen symptoms. Each case is different in intensity. Some patients experience only mild symptoms, and others have severe or even disabling effects.

Some may have frequent problems, while others experience infrequent discomfort. Complications of this disorder include bacterial overgrowth due to rotting of food within the stomach and the development of bezoars (hardened masses of food).

Bezoars can cause nausea, vomiting and obstruction. For those with diabetes, this delayed, sporadic emptying can cause unpredictable spikes in blood-sugar levels, leading to poor control.

Treatment of gastroparesis depends on the severity. In very few cases, the situation may disappear.

For most, it is a chronic condition. There are several medications available.

Some stimulate muscle contractions within the stomach, some reduce bacterial overgrowth, and others reduce nausea and vomiting. Doctors and dietitians may suggest eating several small meals daily to reduce the amount of food in the stomach at any one time.

For more severe cases, puréed or liquid diets may be ordered. In cases in which these restrictions fail to work, feeding tubes may be necessary.

Even this drastic step is not enough in certain instances, and nutrition must be delivered directly into the bloodstream.

This temporary situation allows the body to become stronger and more able to tolerate other sources of nutrition.

It is important to be under the care of specialists familiar with this disorder.

Gastroenterologists are a safe bet, but endocrinologists may be required if diabetes is at the root of the problem. I urge you to return to your physician to discuss your problems and develop an appropriate treatment plan.

You might also need additional testing to determine whether there is an underlying cause or whether you are one of the unfortunate people who develops the condition for no known reason.

Doctor Gott is a retired physician and the author of the book "Dr. Gott's No Flour, No Sugar Diet," available at most chain and independent bookstores, and the recently published "Dr. Gott's No Flour, No Sugar Cookbook." Write directly to Dr. Gott c/o United Media, 200 Madison Ave., 4th fl., New York, NY 10016.