What Is Gastroparesis?

Gastroparesis: An Overview

Generally, food is propelled along the digestive tract by strong muscular contractions.  Gastroparesis is a disease in which the normal movement (motility) of the muscles of the stomach is affected. This abnormality interferes with digestion and causes problems in blood sugar levels as well. The insufficient grinding of food by the stomach and inadequate emptying of food into the intestine from the stomach causes nausea and abdominal pain.

What Causes Gastroparesis?

Gastroparesis can be caused by various factors. These can be singular, or associated with muscular weakness of other parts of the digestive tract, such as the small intestine, colon and esophagus. Common causes include:

• Diabetes mellitus – the most common cause, resulting in damage to the nerves controlling stomach muscles.
• Idiopathic gastroparesis – the second most common cause, where no definitive reason for muscular abnormalities can be found. This is mostly seen in young and middle-aged women.
• Diseases of the stomach’s muscles (such as scleroderma)
• Damage to the nerves that control stomach muscles (such as the vagus nerve)
• Pancreatitis – reflexes sent from the pancreas to the stomach prevent the muscles from functioning smoothly.
• Imbalance of minerals in blood (potassium, magnesium, calcium)
• Narcotic analgesics
• Thyroid disease

Signs and Symptoms of Gastroparesis

Gastroparesis is one of the disorders of the gastrointestinal tract which usually present at early stages of the disease. Common signs and symptoms of gastroparesis include:

• Nausea and vomiting
• Abdominal pain and bloating
• Feeling of fullness even after eating very little amount of food
• Lack of appetite and weight loss
• Generalized body aches and weakness – due to malnutrition
• Changes in blood sugar levels

Examinations And Tests For The Diagnosis Of Gastroparesis

Different medical tests are used to diagnose and confirm gastroparesis. These are as follows:

Gastric Emptying Study

This is the most important diagnostic test for gastroparesis. A light meal, such as toast and eggs, containing small amounts of radioactive material is given to the patient to eat. A scanner placed over the abdomen detects the path of the meal as it passes through the digestive tract. The rate of emptying of the stomach is monitored.

Upper Gastrointestinal (GI) Endoscopy

An endoscope (thin, flexible tube with a camera at one end is used to examine the inside of the esophagus, stomach and upper part of the small intestine (duodenum).

Computerized Tomography (CT) Enterography and Magnetic Resonance (MR) Enterography

These non-invasive tests are highly sensitive and efficient in detecting inflammations or obstructions of the intestines. MR enterography is radiation-free as well.

See Also: Endoscopic Retrograde Cholangio-Pancreatography: Why And When?

Upper Gastrointestinal (GI) Series

A white chalk-like liquid (barium meal) is given to the patient to drink, which coats the digestive tract and allows abnormalities to be spotted via X-rays.

Breath test

The patient drinks a little sugar water. The amount of gas processed (metabolized) by the body is then measured in the breath.

Diagnosis And Treatment Options For Gastroparesis

Who Is At Risk? Risk Factors For Gastroparesis

There are certain factors that make an individual susceptible to developing gastroparesis and related symptoms. Some of the common risk factors:

• Diabetes (Type 1 and Type 2)
• Surgery of the abdomen or esophagus
• Certain medicines which slow the rate of emptying of the stomach
• Radiation therapy
• Scleroderma
• Diseases of the nervous system (Parkinson’s, multiple sclerosis)
• Hypothyroidism

Is Gastroparesis Treatable?

The type of treatment regime adopted depends on the underlying cause of gastroparesis. For diabetic patients, monitoring and controlling the levels of blood sugar can help resolve the problem. For other causes, the following strategies are used:

Dietary Modifications

A dietitian will make changes to your diet so that you may reabsorb maximum amount of calories and nutrients from the food you eat.

• Consume small frequent meals
• Take time to chew food completely
• Drink water while eating
• Exercise a bit after eating – simply go for a walk
• Avoid carbonated drinks
• Dismiss unhealthy habits (smoking, consuming alcohol)
• Include well-cooked vegetables and fruits in your diet instead of eating them raw
• Avoid fibrous foods, such as oranges and broccoli
• Opt for low-fat foods, or cut down the consumption of fatty foods
• Try eating more of purees and soups

Medication

Research is ongoing to find new medicinal treatments for relieving the symptoms of gastroparesis. Currently, there are two types. The first is medication to control nausea and vomiting. These anti-emetic medications include Prochlorperazine (Compro), Thiethylperazine and Diphenhydramine (Benadryl, Unisom), and Ondansetron (Zofran). 

The second type is medication to stimulate the muscles of the stomach. These medications are Metoclopramide (Reglan) and Erythromycin (Eryc, E.E.S). However, metoclopramide has severe side effects and erythromycin resistance is a very common occurrence as well. Domperidone and Cisapride are newer medicines that have fewer side effects, but are still available in only certain settings.

Surgery

Patients who are unable to take any food or liquid by mouth may need surgery. Feeding tubes are used in these cases. However, these tubes are temporary and only used if the cause of gastroparesis is severe and blood sugar levels are not under control. A jejunostomy tube (feeding tube positioned inside the small intestine) is recommended. In some cases, an IV (parenteral) feeding tube is used, which extends directly into a vein in the patients’ chest. The doctor may also insert a gastric venting tube to relieve the pressure exerted by the gastric contents and ease the patients’ abdominal pain and bloating.

New Research – Botulinum Injection

A surgical procedure called a pyloroplasty has been discovered to treat gastroparesis. It involves injecting the toxin botulinum into the pylorus (part of stomach connecting to the duodenum). This enlarges the pylorus and can thus be effective in treating problems related to stomach emptying. However, it is a major operation and its efficacy is still under discussion.   

See Also: Biliary Atresia: Definition, Causes, Symptoms

Prognosis

If the cause of gastroparesis is reversible, such as pancreatitis, the disease subsides once the problem is resolved. In diabetic patients, controlling their blood sugar levels more efficiently helps improve the rate of stomach emptying. However, if the case is irreversible, gastroparesis may increase in severity over time. Moreover, the disease is even more difficult to treat if multiple problems associated with muscular disorders are involved.