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Do you think it’s gastroparesis?

7 tips for talking to your gastroenterologist, with Dr. Kenneth Koch

If you’re struggling with unexplained, chronic nausea and vomiting and think it may be gastroparesis, it can be overwhelming to know where to start—or how to talk to your doctor about it. 

Dr. Kenneth Koch, an experienced gastroenterologist and Medical Director at Enterra Medical, offers his top tips for how to get the most out of your time with your healthcare provider. 

Dr. Kenneth Koch
  • Tip #1: Come prepared 

Almost every patient nowadays feels that they have very little time with their doctor. So, before walking into your appointment, I would advise every patient to have their “story” down. Document what symptoms you’ve been experiencing, when they began, and what’s been done to try to relieve them. If you’ve taken medications, write down which ones and at what doses. If you’ve had tests done, be prepared to talk about them and what the results were. These could all be important clues to the right diagnosis, so if it’s helpful to write it all down, do. 

In my opinion, every doctor-patient relationship should start with a patient telling their story and their doctor listening. And the more organized your story is, the more you and your doctor will be able to accomplish during your visit. 

  • Tip #2: Prioritize your symptoms 

After listening to the history, I always ask my patient, “What is your number one symptom?” 

It’s an especially important question if you suspect you have gastroparesis, because while there are several symptoms associated with gastroparesis—nausea, vomiting, abdominal pain, bloating and feeling full quickly—they’re not specific to the stomach. 

There could be many diseases causing these symptoms, and a doctor’s job is to figure out what the potential causes of that number-one symptom could be. So identifying your most significant or bothersome symptom is an important first step in diagnosis and treatment. 

  • Tip #3: Have clear expectations of your doctor 

What’s not talked about very much is what a good doctor should do before meeting with a patient. First, he or she should come into a consultation visit having reviewed whatever medical history you or your referring doctor have provided. 

Second, and more importantly, your doctor should really work to establish rapport—a harmonious relationship in which you feel heard and respected. 

The “doctor knows best” model of care is very outdated. Good doctor-patient rapport is not transactional, it’s professional and relational. You and your doctor talk about extremely personal things, so he or she should do their best to understand not only your symptoms, but who you are as a person and how those symptoms are affecting your life. 

Before the end of your visit, after you’ve had the opportunity to tell your story and prioritize your symptoms, your doctor should essentially do three things: 

  1. Summarize what you’ve talked about. This gives you the chance to make sure you and your doctor have the same understanding about your symptoms and situation—and mention anything that may have been overlooked. 
  2. Talk through possible causes. Taking into account everything you’ve discussed, your doctor should explain potential causes for your number one symptom. Sharing this information helps you understand your possible diagnoses and recommended course of treatment. 
  3. Establish a plan of care. Whether it’s a new medication, a battery of tests, dietary changes, etc., you should leave your appointment with a clear understanding of how you and your doctor will work together going forward to find relief. 

Altogether, these three things are crucial to a positive, trusting relationship—and to finding hope that healing is possible. 

As mentioned earlier, gastroparesis often takes time to diagnose because several symptoms associated with it can have many causes that may need to be excluded. 

So it’s important to understand that a gastroenterologist should do their best to consider and systematically investigate common diseases and disorders for those symptoms. This could involve testing the gallbladder, conducting an endoscopy to find ulcers or obstruction or getting a biopsy to rule out infection, etc. 

However, if all tests come back normal and other conditions are ruled out, your gastroenterologist should start to consider your stomach’s motility—how your stomach’s nerves and muscles are working. 

Two tests for identifying gastroparesis, which is delayed emptying of a test meal from the stomach, are the gastric emptying study (a test done in radiology departments) and the gastric emptying breath test (a test done in the office or at home). One of these diagnostic tests is needed to show delay in stomach emptying to definitively diagnose gastroparesis. 

While gastroparesis can take time to diagnose, it doesn’t mean you can’t advocate for yourself. 

The wealth of good medical information available today makes patients smarter than ever. Read about your symptoms and diagnoses—and don’t be afraid to ask your doctor, “Why haven’t we considered gastroparesis?” Every interaction with your doctor should be a mutually respectful opportunity to communicate, and your questions and concerns are important. 

Similarly, if you feel like your doctor is not really getting to the core of the problem, if they’re not really helping to decrease your symptoms, or if you don’t feel that proper rapport is happening, then it’s even more important to advocate for yourself. Feel empowered to have an honest conversation with your doctor and ask for a referral to someone else who may be able to offer hope and help. 

Dr. Kenneth Koch

Kenneth L. Koch, MD is Emeritus Professor, Section on Gastroenterology and Hepatology at Wake Forest University’s School of Medicine and Atrium Health Wake Forest Baptist Medical Center. He has a career long interest in the electrical activity of the gastrointestinal tract, especially the pacemaker system that controls gastric neuromuscular function. He has published over 180 scientific papers, written 8 books, and contributed almost 50 book chapters related to nausea, gastric dysrhythmias, and gastroparesis. His interests in nausea, gastroparesis and neurostimulation continue as the Medical Director of Enterra Medical, Inc. 

MKT-D-0003, Rev R


Enterra Therapy for treatment of chronic, resistant to medication nausea and vomiting associated with gastroparesis caused by diabetes or an unknown origin in patients aged 18 to 70 years: patients should always discuss potential risks and benefits of the device with their physician.


Authorized by Federal law for use in the treatment of chronic intractable (drug refractory) nausea and vomiting secondary to gastroparesis of diabetic or idiopathic etiology in patients aged 18 to 70 years. The effectiveness of this device for this use has not been demonstrated. What does this mean?