Gastroparesis, which is also named delayed gastric emptying, is a disorder in which it takes much longer than usually for your stomach to empty its contents. The symptoms of gastroparesis are certainly not pleasant and if you think you have it, it's important to know how to react. First, you'll need a basic rundown of what gastroparesis even is.
Well, a healthy stomach has strong muscular contractions that are pushing food on its long and convoluted journey through the digestive tract. Healthy stomachs will have no trouble at all doing this. In people with Gastroparesis, however, the muscles located in the stomach wall will work very poorly or, in some cases, not at all, this is preventing the stomach from emptying its contents properly.
The bad news is that there are currently no available treatments that are able to completely cure gastroparesis. However, the good news is that there are fortunately some dietary changes and certain medications that can sometimes help control the symptoms of gastroparesis.
Let's take a look at what you'll need to know about gastroparesis and what you can do to control the symptoms.
Stomach anatomy and physiology
The stomach is a hollow organ composed primarily of muscle whose role is to storage food. It consists of two parts:
- The upper portion is called the fundus which is where swallowed food and liquid collect.
- The lower portion is called the antrum. This is the stomach grinder.
In healthy individuals the 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 that it is slowly emptied from the stomach into the intestine. Only food which is ground into small particles can be emptied from the stomach because smaller particles are much better digested in the intestine. The ground food coming from the stomach is being well-mixed with the digestive juices of the intestine, pancreas, and liver (bile) and is easily absorbed from the intestine.
It is clear that, when the stomach’s muscles are paralyzed, food is not thoroughly ground and does not empty into the intestine properly. The condition may cause the delayed emptying of solid food, solid and liquid food, or liquid food alone.
Symptoms and causes of gastroparesis
Nausea and vomiting are considered to be the most common signs and symptoms of gastroparesis. Vomiting usually occurs several hours after eating. Sometimes, accumulated stomach enzymes and acids can cause vomiting even if you don't eat.
Symptoms of gastroparesis
In addition to nausea and vomiting, gastroparesis often causes:
- A feeling of fullness after just a few bites
- Abdominal bloating
- Heartburn or gastro-esophageal reflux
- Changes in blood sugar levels
- Lack of appetite
- Weight loss and malnutrition
Causes of gastroparesis
Most of the people do not know that this condition is actually caused by the most important nerve in the body called the vagus nerve.
It helps organizing the complex signals in the digestive tract, including signaling the smooth muscles in the stomach to contract in peristaltic waves. It is easily understood that the damage to the vagus nerve can be the leading cause of gastroparesis, although the disorder can also result from damage to the stomach muscles themselves.
Other possible causes are:
Diabetes
The most common cause of gastroparesis is definitely type 1 or type 2 diabetes. The explanation for this is that over time, high blood glucose levels and their metabolic effects are damaging the vagus nerve and disrupt its normal functioning.
Surgery
It is proven that all the operations which involve the esophagus, the stomach or the upper part of the small intestine can injure the vagus nerve and lead to gastroparesis.
Medications
A lot of commonly prescribed drugs slow stomach emptying and these include:
- narcotic pain medications,
- tricyclic antidepressants and
- calcium channel blockers
- antacids that contain aluminum hydroxide,
- some high blood pressure medications and
- the psychiatric drug lithium
Symptoms usually improve once the medication intake has stopped.
Cancer treatments - chemotherapy
Nausea and vomiting are the common side effects of chemotherapy because most anti-cancer drugs target fast-growing cells throughout the body, including healthy cells in the intestinal tract. However, they are usually temporary.
Other disorders
A number of other medical conditions can cause gastroparesis, including:
- anorexia and bulimia,
- the connective tissue disease scleroderma,
- Parkinson's disease and
- other nervous system illnesses- anorexia nervosa
- metabolic disorders such as hypothyroidism
Risk factors for developing gastroparesis
Diabetes is the leading risk factor for gastroparesis. About one in five people with type 1 diabetes will eventually develop this disorder. People with type 2 diabetes are at the lower risk.
Other factors that make you more likely to develop gastroparesis include:
- taking medications that slow the rate of stomach emptying
- having abdominal surgery,
- certain cancer treatments,
- another medical condition that can damage the stomach nerves or muscles.
Screening and diagnosis
There 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 the conditions that cause similar symptoms. A patient’s medical history may also help clarify the cause of gastroparesis.
Some of these tests are:
Blood tests - to check blood counts and measure chemical and electrolyte levels
Gastric emptying diagnostic tools
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 the abdomen to monitor the rate at which food leaves the stomach.
Gastro-duodenal manometry
A 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
- the strength;
- frequency and
- coordination of muscle contractions.
Upper gastrointestinal (GI) endoscopy
This test is used to rule out other conditions that can cause delayed gastric emptying. During the test, the patient is swallowing a tube with a tiny camera that allows the doctor to scan stomach and small intestine for obstructions.
Electro-gastrogram
Electrical signals control the muscle contractions in your stomach. Electro-gastrogram, is an experimental procedure that records the electrical signals in the stomach before and after eating.
Magnetic resonance imaging (MRI)
This imaging technique tool uses a powerful magnet and radio waves to produce the cross-sectional images of the patient’s body. It is 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 gastroparesis
Management 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 change
Smaller, more frequent meals
A big meal takes longer to digest than a light snack
Low-fiber foods
It is proven that fibers, found mainly in raw fruits and vegetables, whole grains, and legumes, help passing food through the intestinal tract.
Low-fat foods
Most of the doctors recommend avoiding fatty foods, but they may allow small servings of milkshakes or other rich drinks, especially between meals.
Pureed and liquid foods
Almost any kind of food can be pureed, including cooked fruits and vegetables, poached or baked chicken and fish etc.
Nutritional supplements
Since people with this gastric disorder may be deficient in important nutrients, including vitamin B-12, iron and calcium, some nutritional supplements can be crucial.
Water
The vomiting caused by gastroparesis can lead to dehydration, so it's especially important to drink plenty of water.
Feeding tube
Some people with a severe stomach condition can't tolerate any food or liquids. In that case, the doctors recommend placing a feeding tube in the small intestine to bypass the stomach. This tube is usually inserted directly into the small intestine through the 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.
Medications
Two types of medications are being used to reduce the symptoms of gastroparesis and they include:
- Anti-emetics - which help control nausea and vomiting, and
- Prokinetics - which stimulate contractions of the stomach muscles.
The most commonly used medications are:
- Metoclopramide
- Erythromycin
- Cisapride
- Tegaserod
Surgery
An operation may be the 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 stapled or bypassed to help improve stomach emptying.
Emerging therapies
Some emerging therapies include:
- Botulinum toxin (Botox). Botox relaxes the pyloric muscle in some people, thereby allowing the stomach to release more food.
- Electrical gastric stimulation. This is the treatment in which an electric current is used to stimulate stomach contractions. The battery-operated device is surgically implanted and emits mild electrical pulses that help control nausea and vomiting associated with gastroparesis.
Prevention
Because gastroparesis is most common in people with diabetes, controlling blood sugar levels is the best way to help prevent the disorder.
- www.mayoclinic.com
- www.gicare.com
- Photo courtesy of kevygee on Flickr: www.flickr.com/photos/kevygee/3333942627/