Overview of gastroparesis
Gastroparesis is a disorder that occurs when the stomach takes too long to empty food. This disorder, also known as delayed gastric emptying, is a result of abnormal movement of the muscles in the stomach. This can be due to either nerve damage or muscular disease. There’s no known cure for gastroparesis, but medical treatment can help you manage your symptoms.
What causes gastroparesis?
The exact cause of gastroparesis isn’t known, but it’s thought to have something to do with disrupted nerve signals in the stomach. It’s believed that the vagus nerve, which controls the movement of food through the digestive tract, becomes damaged and causes food to be digested slowly or not at all.
A common cause of damage to the vagus nerve is diabetes, specifically diabetes that isn’t well controlled. High levels of blood sugar can change the way the vagus nerve gets its nutrients.
Surgeries that involve the stomach or other digestive organs can also damage the vagus nerve. Infections, medications, and muscle diseases are other causes of gastroparesis. But in many cases, the cause is labeled as idiopathic, which means the reason isn’t known.
Who’s at risk for developing gastroparesis?
Certain health conditions can make it harder for your stomach to empty, increasing your chances of developing gastroparesis. The risk factors include:
What are the symptoms of gastroparesis?
The symptoms of gastroparesis can range from mild to severe. They occur more often in some people than others. The symptoms of gastroparesis can include:
How is gastroparesis diagnosed?
Your doctor will perform a physical exam and ask you questions about your medical history. In order to rule out other possible causes of your symptoms, your doctor will probably want to run some tests. These might include:
- An ultrasound, which uses sound waves to create an image of your organs and can be used to rule out pancreatitis and gallbladder disease.
- An X-ray taken after you drink a liquid containing barium that lets your doctor see if there is any blockage or obstruction in your upper GI tract. This will also allow your doctor to see if there is slow transit of contrast through the stomach.
- An upper endoscopy, which uses a long, thin scope that your doctor guides down your esophagus and into your stomach to evaluate for peptic ulcer or gastritis.
Once your doctor has ruled out other possible causes of your symptoms, they’ll order tests that will confirm that you have gastroparesis. These tests can include:
- A gastric emptying scintigraphy test, which involves eating a small amount of a radioactive substance so your doctor can see how fast food is being digested and emptied from your stomach.
- A SmartPill, which is a capsule that contains a device to track how fast food moves through your digestive tract.
How is gastroparesis treated?
If your gastroparesis is caused by a condition like diabetes, the first step is to improve control of that underlying condition. After that, your doctor may recommend medication, diet changes, and even surgery in some cases.
Your doctor may prescribe one or more medications to treat your gastroparesis. Medicines like prochlorperazine (Compro) and diphenhydramine (Benadryl) are often given to control nausea and vomiting caused by gastroparesis.
Medicines like metoclopramide (Reglan), erythromycin (EES), domperidone (Motilin), and cisapride (Prepulsid, Propulsid) stimulate the stomach muscles and help with digestion. But these drugs can cause side effects. Talk with your doctor to decide which medication is right for you.
If your malnutrition or vomiting remains an issue even with the use of medicine, your doctor may decide that surgery on your stomach is necessary. The goal of surgery for gastroparesis is to help your stomach empty more effectively. Surgery could entail stomach stapling or a stomach bypass procedure.
Seeing a dietitian (an expert on food and nutrition) is a common part of treatment for gastroparesis. A dietitian can suggest foods that your body can digest more easily, allowing your body to absorb more nutrients. Your dietitian might make suggestions like:
- eating well-cooked vegetables and fruit to lower the amount of fiber they contain
- eating mostly low-fat foods
- drinking water during your meal
- avoiding foods that have a lot of fiber, like broccoli and oranges
- eating smaller meals more often
- ensuring adequate time after meals before lying down for bed
- substituting solid foods for pureed or liquid foods
If you have a severe case of gastroparesis, you might not be able to eat solid foods and drink liquids. In this case, you may need a feeding tube until your condition improves.
Uncommon and experimental treatment options
Gastric neurostimulator (Enterra Therapy System)
In a few treatment centers across the United States, doctors are testing a device called a gastric neurostimulator, or Enterra Therapy System. The device releases electrical signals that help control nausea and vomiting. This treatment is mainly used on those with gastroparesis secondary to diabetes or an idiopathic cause, who have nausea and vomiting, and who have not responded to medication.
Botulinum toxin type A
Botulinum toxin type A is a toxin that reduces muscle activity. It has been shown to relax the pyloric sphincter muscle, which is the muscle that controls the flow of food from the stomach to the small intestine. Using botulinum toxin type A on the pyloric sphincter muscle allows the stomach to pass more food into the small intestine.
What are the complications of gastroparesis?
The symptoms associated with gastroparesis, such as vomiting and decreased appetite, can cause dehydration and malnutrition. Dehydration and malnutrition can cause numerous problems, including:
- electrolyte imbalances
- decreased blood pressure
- increased heartbeat
- rapid breathing
- decreased urine output
- weakened immune system
- poor wound healing
- muscle weakness
Gastroparesis causes food to stay in the stomach for too long, which can cause an overgrowth of bacteria. The food can also harden into masses called bezoars that cause nausea, vomiting, and obstruction in the stomach.
Managing blood glucose levels is essential for people with diabetes. Gastroparesis can make it harder to manage those levels.
If you suspect you have gastroparesis, talk to your doctor. They’ll do a thorough exam before diagnosing the condition. If you do have gastroparesis, there are treatment options that can help ease your symptoms.