Gastroparesis

Gastroparesis is a condition that affects the normal functioning of the stomach. The stomach is unable to empty itself of food in a timely manner, leading to a range of symptoms including heartburn, nausea, vomiting, and feeling full quickly after eating. Treatment options for gastroparesis include medications and, in some cases, surgery

Overview 

What is gastroparesis?

Gastroparesis is a medical condition that affects the normal movement of food through the digestive system. The muscles and nerves in the stomach are partially paralyzed, leading to reduced strength and coordination in the movement of the stomach's contents. As a result, the stomach is unable to empty itself of food in the normal manner. This condition can have significant impacts on an individual's overall health and well-being.

This is a common condition in people who've had diabetes for a long time, but it may also occur in other situations. Gastroparesis can be misdiagnosed and is sometimes mistaken for an ulcer, heartburn or an allergic reaction. In people without diabetes, the condition may relate to acid reflux.

SYMPTOMS AND CAUSES

What causes gastroparesis?

Gastroparesis is a condition that occurs when the muscles in the stomach and intestine do not work properly due to damage to the vagus nerve. The vagus nerve, which is responsible for contracting the stomach muscles and aiding in the movement of food through the digestive tract, may be damaged by diabetes, leading to gastroparesis. This can cause food to become stuck in the stomach, disrupting the normal digestion process. 

Some other cause of gastroparesis 

1. Diabetes: High blood sugar levels can damage the nerves that control the muscles in the stomach, leading to gastroparesis.
2. Abdominal surgery: Gastroparesis can occur as a result of damage to the nerves or muscles in the stomach during abdominal surgery.
3. Infections: Certain infections, such as a viral infection, can cause inflammation in the stomach and disrupt the normal muscle contractions that help move food through the digestive system.
4. Medications: Some medications, such as certain antidepressants and opiate painkillers, can slow down the movement of food through the digestive system.
5. Other medical conditions: Gastroparesis can also be caused by other medical conditions, such as scleroderma (a condition that affects the skin and internal organs) and Parkinson's disease.

What are the symptoms of gastroparesis?

Gastroparesis is a condition that affects the normal spontaneous movement of the muscles (peristalsis) in the wall of the stomach. It can cause a variety of symptoms, including:

1. Nausea and vomiting: This is often the most common symptom of gastroparesis.
2. Abdominal bloating and discomfort: Gastroparesis can cause the stomach to become distended and uncomfortable.
3. Weight loss: Gastroparesis can cause weight loss due to a lack of appetite or due to malnutrition as a result of the inability to properly digest food.
4. Acid reflux: Gastroparesis can cause acid reflux, which is a condition in which stomach acid flows back into the esophagus.
5. Poor blood sugar control: Gastroparesis can cause problems with blood sugar control in people with diabetes, as food is not moving through the intestines at a normal rate.
6. Constipation or diarrhea: Gastroparesis can cause constipation or diarrhea, depending on how severe the condition is.
7. Loss of appetite: Some people with gastroparesis may lose their appetite due to the symptoms of the condition.

What are the complications of gastroparesis?

Gastroparesis is a condition in which the muscles of the stomach do not contract properly, which can cause food to move through the digestive system more slowly than normal. This can lead to a number of complications, including:

1. Nutritional deficiencies: If food remains in the stomach for too long, it may not be fully digested and absorbed, which can lead to deficiencies in essential nutrients.
2. Dehydration: The digestive process helps to absorb fluids, so if food moves through the system more slowly, it can lead to dehydration.
3. Malnutrition: Similar to nutritional deficiencies, malnutrition can occur if the body is not getting enough nutrients from the food being consumed.
4. Weight loss: Because food is not being properly digested and absorbed, it can lead to weight loss.
5. Acid reflux: When food remains in the stomach for a longer period of time, it can increase the risk of acid reflux, which can cause heartburn and other symptoms.
6. Blockages: In severe cases, food can become stuck in the stomach, which can lead to blockages in the digestive system. This can be a serious complication that requires medical attention.
7. Diabetes complications: People with diabetes are at a higher risk of developing gastroparesis, and the condition can also make it more difficult to manage blood sugar levels.

DIAGNOSIS AND TESTS

How is gastroparesis diagnosed?

To diagnose gastroparesis, your doctor may use a combination of the following methods:

1. Physical examination: Your doctor will ask about your symptoms and perform a physical examination to look for signs of gastroparesis.
2. Medical history: Your doctor will ask about your medical history, including any previous gastrointestinal issues you may have had and any medications you are currently taking.
3. Blood tests: Your doctor may order blood tests to check for nutrient deficiencies or infections that could be causing your symptoms.
4. Imaging tests: Your doctor may order imaging tests, such as an abdominal CT scan or an upper gastrointestinal (GI) series, to get a better view of your digestive system.
5. Endoscopy: Your doctor may perform an endoscopy to examine the inside of your stomach and intestines. During the procedure, a thin, flexible tube with a camera on the end is inserted through your mouth and into your stomach.
6. Gastric emptying study: This test measures how long it takes food to empty from your stomach. You will be given a meal that is labeled with a substance that can be detected by a special camera. The camera will take pictures of your stomach at regular intervals to see how quickly the labeled food leaves your stomach.
7. SmartPill test: This test involves swallowing a small device that measures the time it takes food to pass through your digestive system. The device sends the data it collects to a receiver that you wear on a belt or carry in a bag.

MANAGEMENT AND TREATMENT

How is gastroparesis treated?

Gastroparesis is a chronic condition that affects the normal movement of the muscles in the stomach, leading to difficulty in digestion. It is not curable, but the symptoms can be managed through various treatment options. Those who have diabetes should take steps to regulate their blood glucose levels, as this can help alleviate some of the issues associated with gastroparesis.

Some people may benefit from medications, including:

1. Reglan: You take this drug before you eat, and it causes your stomach muscles to contract to help move food out of your stomach. Reglan also helps cut down on vomiting and nausea. Side effects include diarrhea and, rarely, a serious neurological (nerve) disorder.
2. Erythromycin: This is an antibiotic that also causes stomach contractions and helps move food out. Side effects include diarrhea and development of resistant bacteria from taking the antibiotic for a long time.
3. Antiemetics: These are drugs that help manage nausea.

Surgery for gastroparesis

Gastric electrical stimulation is a surgical procedure that aims to alleviate the symptoms of gastroparesis, including nausea and vomiting, in individuals who have not responded to medication. During the procedure, a small device called a gastric stimulator is inserted into the patient's abdomen. This stimulator has two leads that are attached to the patient's stomach and deliver mild electric shocks in order to stimulate the stomach muscles and reduce vomiting. The intensity of the electric shocks can be adjusted as needed, and the device is powered by a battery that lasts for up to a decade.

Gastric bypass surgery is a procedure that aims to alleviate symptoms of gastroparesis by creating a small stomach pouch from the upper portion of the stomach and attaching the lower half of the small intestine directly to it. This effectively limits the amount of food that can be consumed. This type of surgery has been found to be more effective for individuals with both obesity and diabetes in comparison to medication or gastric stimulation.

Are there any other treatments for gastroparesis?

A newer treatment for gastroparesis is called per oral pyloromyotomy (POP). This is a nonsurgical procedure in which your healthcare provider inserts an endoscope (a long, thin, flexible instrument) into your mouth and advances it to your stomach. Your provider then cuts the pylorus, the valve that empties your stomach, which allows food to move from your stomach to your small intestine more easily.

In a severe case of gastroparesis, your doctor may decide you would benefit from a feeding tube, or jejunostomy tube. The surgeon inserts the tube through your abdomen into your small intestine. To feed yourself, you put nutrients into the tube, and they go directly into your small intestine. This way, they go around the stomach and get into your bloodstream more quickly. The jejunostomy tube is usually a temporary measure.

Another treatment option is intravenous, or parenteral, nutrition. This is a feeding method in which nutrients go directly into your bloodstream through a catheter placed into a vein in your chest. Like a jejunostomy tube, parenteral nutrition is meant to be a temporary measure for a severe case of gastroparesis.

Should I change my diet if I have gastroparesis?

One of the best ways to help manage the symptoms of gastroparesis is to change your daily eating habits. For instance, instead of three meals a day, you can eat six small meals. In this way, there is less food in your stomach — you won’t feel as full, and it'll be easier for the food to leave your stomach.

Another important factor is the texture of food. Your provider may recommend liquids and low residue foods (for example, you should eat applesauce instead of whole apples with intact skins).

You should also avoid foods that are high in fat (which can slow down digestion) and fiber (which is difficult to digest).

References: 

• The National Institute of Diabetes and Digestive and Kidney Diseases. Gastroparesis.
• Landreneau, J.P., Strong, A.T., El-Hayek, K. et al. Laparoscopic pyloroplasty versus endoscopic per-oral pyloromyotomy for the treatment of gastroparesis. 
• Gastroparesis Wikipedia