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May 19, 2006
Gastroparesis: Causes, risk factors and prevention
by SirGan|
Gastroparesis, also called delayed gastric emptying, is a disorder in which the stomach takes too long to empty its contents. Normally, strong muscular contractions are pushing food on its long and convoluted journey through digestive tract. But, when we talk about Gastroparesis, the muscles in the stomach wall work poorly or not at all, preventing stomach from emptying properly.
Big problem is that still- no available treatment can cure gastroparesis, although dietary changes and certain medications sometimes help control symptoms of gastroparesis.
Stomach anatomy and physiologyThe stomach is a hollow organ composed primarily of muscle which role is to storage food. It has two parts:
Normally- food in the stomach is ground into tiny pieces by the constant churning that is generated by the contractions of the stomach’s muscles. After this process- it slowly is emptied from the stomach into the intestine. So it is easy to assume that - only food which is grounded into small particles can be emptied from the stomach because smaller particles are digested much better in the intestine. After this- emptied food is being well-mixed with the digestive juices of the intestine, pancreas, and liver (bile) and absorbed well from the intestine.
So, it is logical to assume that, when the stomach’s muscles are paralyzed, food is not thoroughly ground and does not empty into the intestine normally. This may be delayed emptying of solid food, solid and liquid food, or liquid food alone.
Symptoms of gastroparesisNausea and vomiting are considered to be the most common signs and symptoms of gastroparesis. Vomiting usually occurs several hours after eating. Experts are saying that it occurs when the patient’s stomach is full of undigested food and normal stomach secretions. Sometimes, accumulated stomach enzymes and acids can cause vomiting even if you don't eat.
In addition to nausea and vomiting, gastroparesis often causes:
Causes of gastroparesisAlthough most people don’t know a lot about this, it is all about one, probably the most important nerve in the body, called the vagus nerve.
Other possible causes are:
The most common cause of gastroparesis is definitely type 1 or type 2 diabetes. The mechanism is well studied! According to most probable theory- over time, high blood glucose levels and their metabolic effects are damaging the vagus nerve and disrupt its normal functioning.
It is proven that all the operations which are involving the esophagus, the stomach or the upper part of the small intestine can injure the vagus nerve and lead to gastroparesis.
Many commonly prescribed drugs slow stomach emptying and the most common are
Symptoms usually improve once the medication is stopped.
Nausea and vomiting are common side effects of chemotherapy because most anti-cancer drugs target fast-growing cells throughout the body, including healthy cells in the intestinal tract. The nausea and vomiting are usually temporary.
A number of other medical conditions can cause gastroparesis, including:
Risk factors for developing gastroparesisDiabetes is the leading risk factor for gastroparesis. About one in five people with type 1 diabetes will eventually develop the disorder. The risk is less for people with type 2 diabetes.
Other factors that make you more likely to develop gastroparesis include:
Screening and diagnosisThere are several diagnostic tools and tests which can determine the exact nature of this condition. Some tests check specifically for signs of the disorder; others rule out conditions that cause similar symptoms. A patient’s medical history may also help clarify the cause of gastroparesis. Some of these tests are:
Gastric emptying studies are usually considered the most accurate way to diagnose gastroparesis. In the most common test, patient is eating a meal in which a solid food contains a small amount of radioactive material, after which-a scanner which is made to detect the radiation is placed over abdomen to monitor the rate at which food leaves stomach.
Doctor puts a pressure-sensitive plastic tube down a patient’s throat and into stomach and small intestine. The tube is connected to a computer that monitors
This test is used to rule out other conditions that can cause delayed gastric emptying. During the test, patient is swallowing a tube with a tiny camera that allows your doctor to scan stomach and small intestine for obstructions.
Electrical signals control the muscle contractions in your stomach, so- an electro-gastrogram, an experimental procedure records the electrical signals in stomach before and after eating.
This imaging technique tool uses a powerful magnet and radio waves to produce cross-sectional images of patient’s body. It's used to diagnose a broad range of conditions, including various cancers, but researchers are also studying the use of real-time MRI to help evaluate stomach motility.
Sometimes, in an effort to rule out other digestive conditions, an endoscopy and ultrasound may be performed.
Treatment of gastroparesisManagement of gastroparesis centers on hydration, dietary manipulation, nutritional supplementation, and pharmacologic therapy after gastro duodenal disease, systemic disease and offending drugs have been excluded.
EATING HABITS CHANGES
This is because a big meal takes longer to digest than a light snack
It is proven that fibers, found mainly in raw fruits and vegetables, whole grains, and legumes, help passing food through the intestinal tract.
Most of the doctors recommend avoiding fatty foods, but they may allow small servings of milkshakes or other rich drinks, especially between meals.
Although not many people know about this-almost any food can be pureed, including cooked fruits and vegetables, poached or baked chicken and fish
Because people with this gastric disorder may be deficient in important nutrients, including vitamin B-12, iron and calcium, some nutritional supplements could be crucial!
The vomiting caused by gastroparesis can lead to dehydration, so it's especially important to drink plenty of water.
Some people with severe stomach can't tolerate any food or liquids. In that case, doctors recommend placing a feeding tube in the small intestine to bypass the stomach! The tube is usually inserted directly into your small intestine through your skin and it is usually temporary. It is only used when gastroparesis is severe or when blood sugar levels can't be controlled by any other method.
MEDICATIONSTwo types of medications are being used to reduce the symptoms of gastroparesis and they include:
Most commonly used medications are:
SURGERYAn operation may be an option when all other measures fail to provide relief from severe nausea and vomiting or malnutrition. The most common operation is one in which the lower part of the stomach is being be stapled or bypassed to help improve stomach emptying.
EMERGING THERAPIESSome emerging therapies include:
PreventionBecause gastroparesis is most common in people with diabetes, controlling blood sugar levels is the best way to help prevent the disorder.
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